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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 Download5 Pages / 1,182 Words

Course Code: 3034PHM
University: Griffith University

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

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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Cite This Work
To export a reference to this article please select a referencing stye below:

APA
MLA
Harvard
OSCOLA
Vancouver

My Assignment Help. (2021). Evidence Based Practice. Retrieved from https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

“Evidence Based Practice.” My Assignment Help, 2021, https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

My Assignment Help (2021) Evidence Based Practice [Online]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html[Accessed 18 December 2021].

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

My Assignment Help. Evidence Based Practice [Internet]. My Assignment Help. 2021 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

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Selecting expository essay topics or research essay topics is not an easy task. You need to conduct extensive research in order to choose a compelling topic that is relatively less known to people. Moreover, good research paper topics should have a wide scope of investigation options so that you can provide validations. Experts at MyAssignmenthelp.com provide valuable insight into choosing interesting essay topics to write about. Years of experience have provided them with the efficiency of retrieving the necessary details to make an offbeat topic stand out.

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Introduction
According to the researchers, it can be said that the management of the health care organizations has become a difficult task nowadays and the reason behind this is the occurrence of various issues in this sector (Hall et al., 2014). Therefore, the administrative employees of the organization should incorporate various revolutionized strategies for enriching the worth of care provided by the hospital to its clients and re…
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Free Samples

3034PHM Evidence Based Practice

.cms-body-content table{width:100%!important;} #subhidecontent{ position: relative;
overflow-x: auto;
width: 100%;}

3034PHM Evidence Based Practice

0 Download5 Pages / 1,182 Words

Course Code: 3034PHM
University: Griffith University

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

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 Download5 Pages / 1,182 Words

Course Code: 3034PHM
University: Griffith University

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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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My Assignment Help. (2021). Evidence Based Practice. Retrieved from https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

“Evidence Based Practice.” My Assignment Help, 2021, https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

My Assignment Help (2021) Evidence Based Practice [Online]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html[Accessed 18 December 2021].

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

My Assignment Help. Evidence Based Practice [Internet]. My Assignment Help. 2021 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

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Selecting expository essay topics or research essay topics is not an easy task. You need to conduct extensive research in order to choose a compelling topic that is relatively less known to people. Moreover, good research paper topics should have a wide scope of investigation options so that you can provide validations. Experts at MyAssignmenthelp.com provide valuable insight into choosing interesting essay topics to write about. Years of experience have provided them with the efficiency of retrieving the necessary details to make an offbeat topic stand out.

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Assignment 1
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I have conducted a survey at my workplace maned Lady’s Hospice and Care Services to observe the working environment. The aim of the survey is to find if it is a safe, healthy, secured and fulfilling place to work. A visual survey was conducted to locate and record the safety signs in the workplace. The objective of the survey is to observe and list different types of signs, location, their prom…
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Palliative care services are designed to improve the life of patient with progressive disease. People receiving palliative care have illness that has no prospect of cure.  As per the World Health Organisation, palliative care is a care given to patient suffering from life threatening illness to improve their quality of life by preventing and providing relief from sufferings by early recognition , assessment and trea…
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Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) is the spectrum of medical conditions caused due to human immunodeficiency virus (HIV) following which the patient suffers from a series medical complications due to suppression of the immune system of the body. With the progression of the disease, the patient is likely to suffer from a wide range of infections like tuberculosis and other opportu…
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Introduction
According to the researchers, it can be said that the management of the health care organizations has become a difficult task nowadays and the reason behind this is the occurrence of various issues in this sector (Hall et al., 2014). Therefore, the administrative employees of the organization should incorporate various revolutionized strategies for enriching the worth of care provided by the hospital to its clients and re…
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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 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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UploadUnique Document

DocumentUnder Evaluation

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Total 5 pages

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unique.

Cite This Work
To export a reference to this article please select a referencing stye below:

APA
MLA
Harvard
OSCOLA
Vancouver

My Assignment Help. (2021). Evidence Based Practice. Retrieved from https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

“Evidence Based Practice.” My Assignment Help, 2021, https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

My Assignment Help (2021) Evidence Based Practice [Online]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html[Accessed 18 December 2021].

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

My Assignment Help. Evidence Based Practice [Internet]. My Assignment Help. 2021 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/disseminating-the-findings.html.

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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

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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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I have conducted a survey at my workplace maned Lady’s Hospice and Care Services to observe the working environment. The aim of the survey is to find if it is a safe, healthy, secured and fulfilling place to work. A visual survey was conducted to locate and record the safety signs in the workplace. The objective of the survey is to observe and list different types of signs, location, their prom…
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Palliative care services are designed to improve the life of patient with progressive disease. People receiving palliative care have illness that has no prospect of cure.  As per the World Health Organisation, palliative care is a care given to patient suffering from life threatening illness to improve their quality of life by preventing and providing relief from sufferings by early recognition , assessment and trea…
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Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) is the spectrum of medical conditions caused due to human immunodeficiency virus (HIV) following which the patient suffers from a series medical complications due to suppression of the immune system of the body. With the progression of the disease, the patient is likely to suffer from a wide range of infections like tuberculosis and other opportu…
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Leadership in the hospital is the ability to influence the staff toward providing quality health care. Leadership involves influencing human behavior to create a positive working environment (Langlois, 2012). Good leadership enables healthy relationships among staffs in the hospital enhancing quality delivery of health care services. Leadership is responsible to building teams that have trust, respect, support and effecti…
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According to the researchers, it can be said that the management of the health care organizations has become a difficult task nowadays and the reason behind this is the occurrence of various issues in this sector (Hall et al., 2014). Therefore, the administrative employees of the organization should incorporate various revolutionized strategies for enriching the worth of care provided by the hospital to its clients and re…
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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

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Discuss about the Evidence Based Practice for Professional and Clinical Judgment.
 
Answer:

It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014).
There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanner’s model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016).
Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013).
The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013).
The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm.
Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013).
The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014).
The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference between the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013).
 
Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected.
The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors.
Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training to the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014).
Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19.
Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group.
It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received.
Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016).
My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research.
 
References
Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.
Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse Education in Practice, 19, pp.84-90.
Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis. Journal of Marital and Family Therapy, 39(1), pp.17-27.
Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..                                          

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ITC542 Internetworking With TCP/IP
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Course Code: ITC542
University: Charles Sturt University

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Answers:
1.
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:
With good transferring of the time sensitive data like the audio or the video.
The suit for the multiplexing.
2.
CSMA/CD is set with the operations wi…
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NURS11159 Introduction To Nursing
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Answer
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

0 Download7 Pages / 1,670 Words

Course Code: 3034PHM
University: Griffith University

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Country: Australia

Question:
Discuss about the Evidence Based Practice for Professional and Clinical Judgment.
 
Answer:

It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014).
There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanner’s model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016).
Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013).
The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013).
The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm.
Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013).
The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014).
The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference between the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013).
 
Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected.
The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors.
Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training to the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014).
Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19.
Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group.
It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received.
Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016).
My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research.
 
References
Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.
Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse Education in Practice, 19, pp.84-90.
Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis. Journal of Marital and Family Therapy, 39(1), pp.17-27.
Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..                                          

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My Assignment Help. ‘Evidence Based Practice’ (My Assignment Help, 2018) accessed 18 December 2021.

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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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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…
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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…
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ITC542 Internetworking With TCP/IP
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Course Code: ITC542
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Answers:
1.
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:
With good transferring of the time sensitive data like the audio or the video.
The suit for the multiplexing.
2.
CSMA/CD is set with the operations wi…
Read
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Australia Brunswick Management industrial relations in Asia-pacific region  University of New South Wales Masters in Business Administration 

NURS11159 Introduction To Nursing
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University: Central Queensland University

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Answer
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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Free Samples

3034PHM Evidence Based Practice

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

0 Download7 Pages / 1,670 Words

Course Code: 3034PHM
University: Griffith University

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

Country: Australia

Question:
Discuss about the Evidence Based Practice for Professional and Clinical Judgment.
 
Answer:

It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014).
There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanner’s model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016).
Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013).
The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013).
The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm.
Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013).
The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014).
The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference between the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013).
 
Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected.
The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors.
Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training to the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014).
Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19.
Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group.
It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received.
Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016).
My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research.
 
References
Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.
Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse Education in Practice, 19, pp.84-90.
Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis. Journal of Marital and Family Therapy, 39(1), pp.17-27.
Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..                                          

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My Assignment Help. (2018). Evidence Based Practice. Retrieved from https://myassignmenthelp.com/free-samples/evidence-based-practice-professional-and-clinical-judgment.

“Evidence Based Practice.” My Assignment Help, 2018, https://myassignmenthelp.com/free-samples/evidence-based-practice-professional-and-clinical-judgment.

My Assignment Help (2018) Evidence Based Practice [Online]. Available from: https://myassignmenthelp.com/free-samples/evidence-based-practice-professional-and-clinical-judgment[Accessed 18 December 2021].

My Assignment Help. ‘Evidence Based Practice’ (My Assignment Help, 2018) accessed 18 December 2021.

My Assignment Help. Evidence Based Practice [Internet]. My Assignment Help. 2018 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/evidence-based-practice-professional-and-clinical-judgment.

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MyAssignmenthelp.com has become one of the leading assignment help provider in New York City and Boston. We provide top class auditing assignment help. Not only auditing, but we also cover more than 100 subjects and our writers deal with all types of assignments with utmost expertise. To make writing process faster and accurate, we have segmented our assignment experts’ teams as per their expertise on writing different types of assignments. We guaranteed that students who buy our assignment online get solutions worth their investment.

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NR510 Leadership And Role Of The Advanced Practice Nurse
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Course Code: NR510
University: Chamberlain University

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Country: United States

Answer:
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 …
Read
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Australia Bakersfield Management University of New South Wales Masters in Business Administration 

CNA741 Foundations Of Mental Health Nursing Theory 2
Download :
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14

Course Code: CNA741
University: University Of Tasmania

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

Country: Australia

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
Tags:
Australia Surry Hills Medical Healthcare University of New South Wales 

NUR2107 Person Centered Mental Health Care
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9

Course Code: NUR2107
University: Monash University

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

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
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Tags:
Australia Clayton Management University of New South Wales Masters in Business Administration 

ITC542 Internetworking With TCP/IP
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3

Course Code: ITC542
University: Charles Sturt University

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Country: Australia

Answers:
1.
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:
With good transferring of the time sensitive data like the audio or the video.
The suit for the multiplexing.
2.
CSMA/CD is set with the operations wi…
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NURS11159 Introduction To Nursing
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Answer
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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Course Code: 3034PHM
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Question:
Discuss about the NuHypertensive Patients.
 
 
Answer:
Introduction

High blood pressure is a health condition that is related to abnormal functioning of the heart. The heart uses too much energy to force blood through the blood vessels, that is, arteries and veins. This further hardens the blood vessels thus making more hard for the blood to go through easily. It can be referred to as a condition whereby the heart pumps blood at a high rate and speed than the normal recommended rate. This is a fatal health problem that must be dealt with as soon as possible the moment it is noticed, else it may lead to death of the victim. The condition is caused by several factors, most of which are caused by human activities or lifestyle. Medical research shows that majority of heart related ailments start as a result of the food eaten by people, the lifestyle they are having, and so many other human activities. However, research indicates that high blood pressure is a manageable condition and the patient can still live the normal lifestyle they had before the attack commenced. If they follow the prescribed measures given to them by the doctors without fail, then there are high chances that the hypertension condition will cease to exist and the patient will go back to his or her normal life condition. The lowest reading of blood pressure is diastolic, which the blood pressure rate must not go below. Blood pressure has also the highest reading called systolic, which is also fatal if the pressure rate exceeds. Abnormal blood pressure is caused by among other things; smoking, stress, genetics, being obese, eating too much salt in foods. Sleep apnea and many other.
Hypertensive Patients
Hypertension is one of the circulatory disorders that affect majority of people in the world currently. Medical statistics have revealed shocking figures about the number of people suffering from hypertension in the world. One out of every three people who were interviewed have hypertension symptoms or suffered from the condition previously. According to the statistics, men of a certain age group are the most likely to be affect compared to their women counterparts (Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth, 2012). However, we are informed that at some point, both the gender suffers the same fate. This is due to the fact that the circulation system of older people functions almost the same way and at the same rate. This is attributed to the fact that majority of these people have blood pressure rate higher than 140/90 mm Hg, which according to the medics, is very high and can easily lead to heart failure and other heart related illnesses (Esler, et al, 2008). The following are signs and symptoms characterised by hypertension:

Headrace
Sleepiness
Comma
Confusion
Severe headache.
Fatigue or confusion.
Vision problems.
Chest pain.
Difficulty breathing.
Irregular heartbeat.
Blood in the urine.
Pounding in your chest, ears, neck, etc.

 
Hypertensive patients can manage the condition by visiting medical facilities and getting professional advice and treatment from qualified medical personnel. The treatment involves drugs administration and change of lifestyle as well (Gallego, et al, 2013). Doctors address that the first step towards hypertension treatment and management is change of lifestyle. Lifestyles of individuals affects the levels of BP. Research indicates that a decrease the levels of BP concentration by as little as 2 mm Hg is able to lower the chances of heart attack by close to 15% and as well reduce the risks of getting artery related coronary diseases or infections by close to between 6% and 7% in a community setup. The patients are advised to do enough physical exercises. They are also required to eat the foods that aid in healing of blood vessels and their proper growth as well as healing. Smoking cigarette hardens the walls of arteries in the body thus making it hard for blood to flow easily. This causes the heart to pump blood using excessive force which leads to heart attack. Hypertension has also been characterised by too much intake of alcohol (Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension, 2012). It, therefore, means that everyone within the community setup should take less of alcoholic beverages or avoid it altogether for a better functioning heart, which means that the rate of blood pressure will be normal. Hypertensive patients also need to reduce the overall body weight. Australian medical journal indicates clearly that obese people are at a higher risk of suffering from hypertension as compared to their non-obese counterparts (Global Hypertension Market and Competitive Landscape, 2016). This is because the heart uses too much energy to push blood to the entire body of the overweight person, thus making the hear become fatigue at later lead to hypertension.
Doctors can also use medical procedures to help treat hypertension. However, the type of drugs they (doctors) give depends on a number of factor. First, they need to know the causes of the hypertension, they will monitor the medical history of the patients to know what other health problems the patient is suffering from. the doctor may then give the patient anti-hypertensive drugs which will also reduce hypertension and its effects. Doctors do give ‘water pills’, which are also referred to as diuretics (Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets, 2016). Diuretics are used to make the kidneys work harder to remove excessive salt and water from the body. This is done because the body does not have enough water so removal of excess salt means that the body will not need more water to neutralize the salty contents. Another medicine administered is called better-blocker. These medicines are generally used to slow down the rate of heart beat and also – prevent the heart from squeezing and un-squeezing very hard. Thus reducing the energy needed to pump blood while also making the blood flow using much reduced force (Gu & Dong, 2016).
 
Amlodipine
This is another method used to treat and manage hypertension, also known as high blood pressure. It should be remembered that a low blood pressure prevents the victim patient from contacting more diseases such as kidney problems, stroke, heart attack and other related ailments. Amlodipine is used by medics to relax blood vessel such as veins and arteries. The drug is administered to the hypertensive patient so that the pumped blood from the heart can go through the vessels with much ease. Medical reports also reveal that people who suffer from hypertension experience a certain level of chest pain, a medical condition known as angina (Keogh & Wlodarczyk, 2004). Apart from relaxing blood vessels, amlodipine is also used to prevent angina. The drug is used to boost the patient’s ability to do physical exercises, which goes hand in hand to preventing hypertension. When administered, amlodipine also reduces the rate at which the chest pain occurs. This will make the patient have more easy and relaxed time thus making him or her feel better. However, the doctors warn that amlodipine is only for reducing the chest pain felt by hypertensive patient and should not be used for treatment purposes (Keogh, 2011).
Amlodipine is administered via mount. Others may prefer to take the medicine alongside food or without. But this must only be according to the prescriptions given by the doctor and not a self-choice. It always preferred to be taken only once every day for it to be effective and not to bring more harm to the patient. However, the full dosage given by the medical personnel depends on several factors including response of the patient to the drugs given so far and the condition of the patient medically. Amlodipine must be taken regularly in order for it to have best effect in the body (Krum, 2009). Medics also say that it is important to take the medicine at the same time daily to avoid forgetting and possible skips. Patients are required to continue taking amlodipine even after. The feel that they are now fine and free from hypertension. This is because a higher percentage of hypertensive patient do not have a strong feeling of being sick and so they might misinterpret their condition and stop the treatment. The following are other uses of amlodipine and what is treats;

Hypertension medications
Angina prevention
Other types of angina, for instance cases where chest pains are very strong
Chronic medication which, those that show characteristics of angina.  

Chlorthalidone
This is a medical tablet used to treat hypertension. Just like amlodipine, chlorthalidone is used to get excess water that is not needed by the body and excess salt out of the body through urine. Chlorthalidone is taken as a pill after food and should not be taken without eating (Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery, 2015). This is because of its side effects to the patient. Medical personnel warn that in order to maximize its functionality in the body, chlorthalidone should be taken every once every day as prescribed by the physician. According to research, the drug maximizes its effects in the body when taken during morning hours as compared to other times of the day. This, therefore, mean that the drug should be taken immediately after breakfast every day. We are informed that chlorthalidone only controls the blood pressures of people but does not cure such ailments. In addition to that, the patients are advised to continue taking the same even if they feel like they need not to take the medicine anymore (Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits, 2013). It is only the doctor who administered the drug can recommend whether to stop it or not. The drug is also used to cure people who are suffering from diabetes insipidus. In addition to that, chlorthalidone also prevents kidney stones, which is most prevalent to patients with calcium in blood. Scholarly information describes that women who are pregnant should not attempt the usage of chlorthalidone, unless it is absolutely necessary to do so (Mentz, et al, 2012). This is because the drug in question causes suppression of milk production in pregnant women, thus may make it difficult to breast feed the infants. The following are the effects of chlorthalidone to the patient taking it;

It causes reduction in potassium and magnesium in the patient’s body.
Increase the levels of uric acid in the human body.
After taking the drug, the patient light-headedness and dizziness as well.
It causes prolonged headache to patients.
The patient faces frequent vomiting most of the time.
Fatigue, after small amount of physical work.
The patient also feels abdominal pain. Others include but not limited to; fever, breathing difficulties, severe rushes with skin peel off.

 
Coronary artery diseases (CAD)
This is the most prevalent type of hart related diseases and affects majority of people in Australia. The disease is caused by atherosclerosis and leads to blockage of blood flow to the heart (Nguyen, 2016). Depending on the level of infection, the patient may become asymptomatic until when thrombosis occurs. Research indicates that coronary artery diseases are the leading resinous causes of death nowadays in Australia. The statistics produced by the world health organisation indicates that in every seven people in Australia, at least one has had coronary attack before or is currently suffering from heart related attack (Portal Hypertension Therapeutics, 2012). During diagnosis, the physician will first assess the patient and know his or her medical history and to also known the period which the patient has suffered from this illness. The following is a list of diagnosis procedures that they doctor may carry out.

Electrocardiogram – this is a type of diagnosis whereby electric signals are recorded as they travel to the heart. The process helps the doctor know whether the patient suffered any form of heart attack previously or is in the process, thus giving proper medication. The exercise involves a patient wearing a portable monitor like apparatus from close to 24 hours, thus recording the needed results (Viruell-fuentes, Ponce & Alegría, 2012).
Echocardiogram – this is a machine that uses sound waves to produce graphical images of the heart of the patient. This helps to know whether the entire heart is working towards pumping enough blood to other body parts or not. Research reveals that the parts of the heart that do not contribute immensely toward better operation of the heart may mean signs of heart attack or lower oxygen in those parts (Robergeet al, 2012). This, therefore, shows signs of coronary artery to the heart or other heart related problems.
Stress tests – this method is used mostly when the patient displays sign of coronary artery disease when doing physical activity. At some point, the physician may be forced to use some types of medication instead of physical exercise depending on the level of heart infection and the overall ability of the patent. Flow of blood towards the heart vessels during hours of rest and stressful time can also be taken, a process called nuclear stress test (Strange, et al, 2011). This is whereby a tracer like object, which have got special types of cameras, is injected in the blood stream of the patient. This tracer is, therefore, able to identify specific areas of the heart where there is no enough flow of blood.
Angiogram – the doctor injects a special type of a dye in the coronary arteries. The dye is thin but long tube called catheter. It goes through one of the arteries in the leg straight to the arteries found in the heart. Once it identifies a blockage in the blood vessel where treatment is possibly required, a special type of a balloon is then inflated in to the walls of the artery via the catheter. This widens the arteries thus increasing flow of blood. A mesh, called a stent, is then to continuously keep such an artery open for a specific period of time.
Heart scan – doing computerised heart scans helps the medical personnel know whether the arteries of the heart are blocked or no.

 
Treatment of Coronary Artery Diseases
The most preferred treatment method of CAD is a change in the lifestyle of the patients and the general community (Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756, 2010). People who have been diagnosed with CAD need to do the following to help improve their health standards;

Quit smoking (both active smoking and passive smoking).
Eat healthy foods and balanced diet.
Exercise regularly.
Lose excess weight, through physical exercises.
Reduce stress.

Drugs can also be used to treat or better manage coronary artery diseases as well.
Conclusion
Hypertension is a disease that is associated with malfunctioning of the heart. The heart fails to operate in the normal way as needed for better functioning of the entire body mechanism. Reports indicate that a better number of people living in Australia suffer from this heart condition due to their own lifestyles. Better and healthy living is obtained through change of lifestyle. Research shows that is people change the types of food they eat to include balanced diet and natural vegetables and fruits, then chances of getting hypertension will be reduced by a very high percentage. Amlodipine and chlorthalidone are seen as the most used scientific methods of treating and managing high blood pressure. Both the methods almost work the same, even though doctors who handle hypertensive patients revel that majority of them prefer amlodipine to chlorthalidone because of its less side effects as compared to the later. Australian department of medical research states that majority of its citizens have shown improvement and reduction in rate of hypertension attached. This is attributed to the public knowhow that have been carried out in the entire country, enlightening the dangers of hypertension. During treatment of hypertension, doctors first administer small amount of medication to the patient. After monitoring the healing progress of such a patient, the doctor may decide to continue with more advanced treatments. Patients are then required to follow all the prescriptions given by the doctor strictly so that hypertension conditions can heal much faster. Skipping any of the prescribed medication may lead to a worsening condition and probably more dangers. Doing this also prolongs the healing periods.
 
References
Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth2012, , New York.
Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L. and Brenchley, C., 2008. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clinical and Experimental Pharmacology and Physiology, 35(4), pp.498-502.
Gallego, B., Runciman, W.B., Perez-Concha, O., Liaw, S., Day, R.O., Dunn, A.G. & Coiera, E. 2013, “The management of severe hypertension in Australian general practice”, BMC Health Services Research, vol. 13, pp. 414.
Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension 2012, , New York.
Global Hypertension Market and Competitive Landscape Highlights 2016 – Research and Markets 2016, , New York.
Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets 2016, , New York.
Gu, S., Hu, H. & Dong, H. 2016, “Systematic Review of the Economic Burden of Pulmonary Arterial Hypertension”, PharmacoEconomics, vol. 34, no. 6, pp. 533-550.
Keogh, A. & Wlodarczyk, J. 2004, “Idiopathic- and scleroderma-related pulmonary arterial hypertension: outcomes and QOL on bosentan”, Expert Review of      Pharmacoeconomics & Outcomes Research, vol. 4, no. 5, pp. 505-13.
Keogh, A., Strange, G., McNeil, K., Williams, T.J., Gabbay, E., Proudman, S., Weintraub, R.G., Wlodarczyk, J. and DAlton, B., 2011. The bosentan patient registry: long?term survival in pulmonary arterial hypertension. Internal medicine journal, 41(3), pp.227-234.
Krum, H., Schlaich, M., Whitbourn, R., Sobotka, P.A., Sadowski, J., Bartus, K., Kapelak, B., Walton, A., Sievert, H., Thambar, S. and Abraham, W.T., 2009. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. The Lancet, 373(9671), pp.1275-1281.
Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery 2015, , New York.
Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits 2013, New York.
Mentz, G., Schulz, A.J., Mukherjee, B., Ragunathan, T.E., Perkins, D.W. & Israel, B.A. 2012, “Hypertension: Development of a prediction model to adjust self-reported hypertension prevalence at the community level”, BMC Health Services           Research, vol. 12, pp. 312.
Nguyen, H. V. (2016). Keeping up with the joneses: Neighbourhood wealth and hypertension. Journal of Happiness Studies, 17(3), 1255-1271. doi:https://dx.doi.org/10.1007/s10902-015-9641-9
Portal Hypertension Therapeutics – Pipeline Assessment and Market Forecasts to 2019 2012, New York.
Research and Markets: Pulmonary Arterial Hypertension (PAH) Therapeutics – Global Drug Forecasts and Treatment Analysis to 2020 2012, , New York.
Viruell-fuentes, E., Ponce, N.A. & Alegría, M. 2012, “Neighborhood Context and Hypertension Outcomes Among Latinos in Chicago”, Journal of Immigrant and         Minority Health, vol. 14, no. 6, pp. 959-67.
Roberge, S., Giguère, Y., Villa, P., Nicolaides, K., Vainio, M., Forest, J.C., von Dadelzen, P., Vaiman, D., Tapp, S. and Bujold, E., 2012. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. American journal of perinatology, 29(07), pp.551-556.
Strange, G., Keogh, A., Dalton, B. & Gabbay, E. 2011, “Pharmacoeconomic evidence of bosentan for pulmonary arterial hypertension”, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 11, no. 3, pp. 253-63.
Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756 (2010): 1903-1909.

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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

0 Download14 Pages / 3,308 Words

Course Code: 3034PHM
University: Griffith University

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

Country: Australia

Question:
Discuss about the NuHypertensive Patients.
 
 
Answer:
Introduction

High blood pressure is a health condition that is related to abnormal functioning of the heart. The heart uses too much energy to force blood through the blood vessels, that is, arteries and veins. This further hardens the blood vessels thus making more hard for the blood to go through easily. It can be referred to as a condition whereby the heart pumps blood at a high rate and speed than the normal recommended rate. This is a fatal health problem that must be dealt with as soon as possible the moment it is noticed, else it may lead to death of the victim. The condition is caused by several factors, most of which are caused by human activities or lifestyle. Medical research shows that majority of heart related ailments start as a result of the food eaten by people, the lifestyle they are having, and so many other human activities. However, research indicates that high blood pressure is a manageable condition and the patient can still live the normal lifestyle they had before the attack commenced. If they follow the prescribed measures given to them by the doctors without fail, then there are high chances that the hypertension condition will cease to exist and the patient will go back to his or her normal life condition. The lowest reading of blood pressure is diastolic, which the blood pressure rate must not go below. Blood pressure has also the highest reading called systolic, which is also fatal if the pressure rate exceeds. Abnormal blood pressure is caused by among other things; smoking, stress, genetics, being obese, eating too much salt in foods. Sleep apnea and many other.
Hypertensive Patients
Hypertension is one of the circulatory disorders that affect majority of people in the world currently. Medical statistics have revealed shocking figures about the number of people suffering from hypertension in the world. One out of every three people who were interviewed have hypertension symptoms or suffered from the condition previously. According to the statistics, men of a certain age group are the most likely to be affect compared to their women counterparts (Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth, 2012). However, we are informed that at some point, both the gender suffers the same fate. This is due to the fact that the circulation system of older people functions almost the same way and at the same rate. This is attributed to the fact that majority of these people have blood pressure rate higher than 140/90 mm Hg, which according to the medics, is very high and can easily lead to heart failure and other heart related illnesses (Esler, et al, 2008). The following are signs and symptoms characterised by hypertension:

Headrace
Sleepiness
Comma
Confusion
Severe headache.
Fatigue or confusion.
Vision problems.
Chest pain.
Difficulty breathing.
Irregular heartbeat.
Blood in the urine.
Pounding in your chest, ears, neck, etc.

 
Hypertensive patients can manage the condition by visiting medical facilities and getting professional advice and treatment from qualified medical personnel. The treatment involves drugs administration and change of lifestyle as well (Gallego, et al, 2013). Doctors address that the first step towards hypertension treatment and management is change of lifestyle. Lifestyles of individuals affects the levels of BP. Research indicates that a decrease the levels of BP concentration by as little as 2 mm Hg is able to lower the chances of heart attack by close to 15% and as well reduce the risks of getting artery related coronary diseases or infections by close to between 6% and 7% in a community setup. The patients are advised to do enough physical exercises. They are also required to eat the foods that aid in healing of blood vessels and their proper growth as well as healing. Smoking cigarette hardens the walls of arteries in the body thus making it hard for blood to flow easily. This causes the heart to pump blood using excessive force which leads to heart attack. Hypertension has also been characterised by too much intake of alcohol (Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension, 2012). It, therefore, means that everyone within the community setup should take less of alcoholic beverages or avoid it altogether for a better functioning heart, which means that the rate of blood pressure will be normal. Hypertensive patients also need to reduce the overall body weight. Australian medical journal indicates clearly that obese people are at a higher risk of suffering from hypertension as compared to their non-obese counterparts (Global Hypertension Market and Competitive Landscape, 2016). This is because the heart uses too much energy to push blood to the entire body of the overweight person, thus making the hear become fatigue at later lead to hypertension.
Doctors can also use medical procedures to help treat hypertension. However, the type of drugs they (doctors) give depends on a number of factor. First, they need to know the causes of the hypertension, they will monitor the medical history of the patients to know what other health problems the patient is suffering from. the doctor may then give the patient anti-hypertensive drugs which will also reduce hypertension and its effects. Doctors do give ‘water pills’, which are also referred to as diuretics (Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets, 2016). Diuretics are used to make the kidneys work harder to remove excessive salt and water from the body. This is done because the body does not have enough water so removal of excess salt means that the body will not need more water to neutralize the salty contents. Another medicine administered is called better-blocker. These medicines are generally used to slow down the rate of heart beat and also – prevent the heart from squeezing and un-squeezing very hard. Thus reducing the energy needed to pump blood while also making the blood flow using much reduced force (Gu & Dong, 2016).
 
Amlodipine
This is another method used to treat and manage hypertension, also known as high blood pressure. It should be remembered that a low blood pressure prevents the victim patient from contacting more diseases such as kidney problems, stroke, heart attack and other related ailments. Amlodipine is used by medics to relax blood vessel such as veins and arteries. The drug is administered to the hypertensive patient so that the pumped blood from the heart can go through the vessels with much ease. Medical reports also reveal that people who suffer from hypertension experience a certain level of chest pain, a medical condition known as angina (Keogh & Wlodarczyk, 2004). Apart from relaxing blood vessels, amlodipine is also used to prevent angina. The drug is used to boost the patient’s ability to do physical exercises, which goes hand in hand to preventing hypertension. When administered, amlodipine also reduces the rate at which the chest pain occurs. This will make the patient have more easy and relaxed time thus making him or her feel better. However, the doctors warn that amlodipine is only for reducing the chest pain felt by hypertensive patient and should not be used for treatment purposes (Keogh, 2011).
Amlodipine is administered via mount. Others may prefer to take the medicine alongside food or without. But this must only be according to the prescriptions given by the doctor and not a self-choice. It always preferred to be taken only once every day for it to be effective and not to bring more harm to the patient. However, the full dosage given by the medical personnel depends on several factors including response of the patient to the drugs given so far and the condition of the patient medically. Amlodipine must be taken regularly in order for it to have best effect in the body (Krum, 2009). Medics also say that it is important to take the medicine at the same time daily to avoid forgetting and possible skips. Patients are required to continue taking amlodipine even after. The feel that they are now fine and free from hypertension. This is because a higher percentage of hypertensive patient do not have a strong feeling of being sick and so they might misinterpret their condition and stop the treatment. The following are other uses of amlodipine and what is treats;

Hypertension medications
Angina prevention
Other types of angina, for instance cases where chest pains are very strong
Chronic medication which, those that show characteristics of angina.  

Chlorthalidone
This is a medical tablet used to treat hypertension. Just like amlodipine, chlorthalidone is used to get excess water that is not needed by the body and excess salt out of the body through urine. Chlorthalidone is taken as a pill after food and should not be taken without eating (Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery, 2015). This is because of its side effects to the patient. Medical personnel warn that in order to maximize its functionality in the body, chlorthalidone should be taken every once every day as prescribed by the physician. According to research, the drug maximizes its effects in the body when taken during morning hours as compared to other times of the day. This, therefore, mean that the drug should be taken immediately after breakfast every day. We are informed that chlorthalidone only controls the blood pressures of people but does not cure such ailments. In addition to that, the patients are advised to continue taking the same even if they feel like they need not to take the medicine anymore (Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits, 2013). It is only the doctor who administered the drug can recommend whether to stop it or not. The drug is also used to cure people who are suffering from diabetes insipidus. In addition to that, chlorthalidone also prevents kidney stones, which is most prevalent to patients with calcium in blood. Scholarly information describes that women who are pregnant should not attempt the usage of chlorthalidone, unless it is absolutely necessary to do so (Mentz, et al, 2012). This is because the drug in question causes suppression of milk production in pregnant women, thus may make it difficult to breast feed the infants. The following are the effects of chlorthalidone to the patient taking it;

It causes reduction in potassium and magnesium in the patient’s body.
Increase the levels of uric acid in the human body.
After taking the drug, the patient light-headedness and dizziness as well.
It causes prolonged headache to patients.
The patient faces frequent vomiting most of the time.
Fatigue, after small amount of physical work.
The patient also feels abdominal pain. Others include but not limited to; fever, breathing difficulties, severe rushes with skin peel off.

 
Coronary artery diseases (CAD)
This is the most prevalent type of hart related diseases and affects majority of people in Australia. The disease is caused by atherosclerosis and leads to blockage of blood flow to the heart (Nguyen, 2016). Depending on the level of infection, the patient may become asymptomatic until when thrombosis occurs. Research indicates that coronary artery diseases are the leading resinous causes of death nowadays in Australia. The statistics produced by the world health organisation indicates that in every seven people in Australia, at least one has had coronary attack before or is currently suffering from heart related attack (Portal Hypertension Therapeutics, 2012). During diagnosis, the physician will first assess the patient and know his or her medical history and to also known the period which the patient has suffered from this illness. The following is a list of diagnosis procedures that they doctor may carry out.

Electrocardiogram – this is a type of diagnosis whereby electric signals are recorded as they travel to the heart. The process helps the doctor know whether the patient suffered any form of heart attack previously or is in the process, thus giving proper medication. The exercise involves a patient wearing a portable monitor like apparatus from close to 24 hours, thus recording the needed results (Viruell-fuentes, Ponce & Alegría, 2012).
Echocardiogram – this is a machine that uses sound waves to produce graphical images of the heart of the patient. This helps to know whether the entire heart is working towards pumping enough blood to other body parts or not. Research reveals that the parts of the heart that do not contribute immensely toward better operation of the heart may mean signs of heart attack or lower oxygen in those parts (Robergeet al, 2012). This, therefore, shows signs of coronary artery to the heart or other heart related problems.
Stress tests – this method is used mostly when the patient displays sign of coronary artery disease when doing physical activity. At some point, the physician may be forced to use some types of medication instead of physical exercise depending on the level of heart infection and the overall ability of the patent. Flow of blood towards the heart vessels during hours of rest and stressful time can also be taken, a process called nuclear stress test (Strange, et al, 2011). This is whereby a tracer like object, which have got special types of cameras, is injected in the blood stream of the patient. This tracer is, therefore, able to identify specific areas of the heart where there is no enough flow of blood.
Angiogram – the doctor injects a special type of a dye in the coronary arteries. The dye is thin but long tube called catheter. It goes through one of the arteries in the leg straight to the arteries found in the heart. Once it identifies a blockage in the blood vessel where treatment is possibly required, a special type of a balloon is then inflated in to the walls of the artery via the catheter. This widens the arteries thus increasing flow of blood. A mesh, called a stent, is then to continuously keep such an artery open for a specific period of time.
Heart scan – doing computerised heart scans helps the medical personnel know whether the arteries of the heart are blocked or no.

 
Treatment of Coronary Artery Diseases
The most preferred treatment method of CAD is a change in the lifestyle of the patients and the general community (Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756, 2010). People who have been diagnosed with CAD need to do the following to help improve their health standards;

Quit smoking (both active smoking and passive smoking).
Eat healthy foods and balanced diet.
Exercise regularly.
Lose excess weight, through physical exercises.
Reduce stress.

Drugs can also be used to treat or better manage coronary artery diseases as well.
Conclusion
Hypertension is a disease that is associated with malfunctioning of the heart. The heart fails to operate in the normal way as needed for better functioning of the entire body mechanism. Reports indicate that a better number of people living in Australia suffer from this heart condition due to their own lifestyles. Better and healthy living is obtained through change of lifestyle. Research shows that is people change the types of food they eat to include balanced diet and natural vegetables and fruits, then chances of getting hypertension will be reduced by a very high percentage. Amlodipine and chlorthalidone are seen as the most used scientific methods of treating and managing high blood pressure. Both the methods almost work the same, even though doctors who handle hypertensive patients revel that majority of them prefer amlodipine to chlorthalidone because of its less side effects as compared to the later. Australian department of medical research states that majority of its citizens have shown improvement and reduction in rate of hypertension attached. This is attributed to the public knowhow that have been carried out in the entire country, enlightening the dangers of hypertension. During treatment of hypertension, doctors first administer small amount of medication to the patient. After monitoring the healing progress of such a patient, the doctor may decide to continue with more advanced treatments. Patients are then required to follow all the prescriptions given by the doctor strictly so that hypertension conditions can heal much faster. Skipping any of the prescribed medication may lead to a worsening condition and probably more dangers. Doing this also prolongs the healing periods.
 
References
Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth2012, , New York.
Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L. and Brenchley, C., 2008. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clinical and Experimental Pharmacology and Physiology, 35(4), pp.498-502.
Gallego, B., Runciman, W.B., Perez-Concha, O., Liaw, S., Day, R.O., Dunn, A.G. & Coiera, E. 2013, “The management of severe hypertension in Australian general practice”, BMC Health Services Research, vol. 13, pp. 414.
Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension 2012, , New York.
Global Hypertension Market and Competitive Landscape Highlights 2016 – Research and Markets 2016, , New York.
Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets 2016, , New York.
Gu, S., Hu, H. & Dong, H. 2016, “Systematic Review of the Economic Burden of Pulmonary Arterial Hypertension”, PharmacoEconomics, vol. 34, no. 6, pp. 533-550.
Keogh, A. & Wlodarczyk, J. 2004, “Idiopathic- and scleroderma-related pulmonary arterial hypertension: outcomes and QOL on bosentan”, Expert Review of      Pharmacoeconomics & Outcomes Research, vol. 4, no. 5, pp. 505-13.
Keogh, A., Strange, G., McNeil, K., Williams, T.J., Gabbay, E., Proudman, S., Weintraub, R.G., Wlodarczyk, J. and DAlton, B., 2011. The bosentan patient registry: long?term survival in pulmonary arterial hypertension. Internal medicine journal, 41(3), pp.227-234.
Krum, H., Schlaich, M., Whitbourn, R., Sobotka, P.A., Sadowski, J., Bartus, K., Kapelak, B., Walton, A., Sievert, H., Thambar, S. and Abraham, W.T., 2009. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. The Lancet, 373(9671), pp.1275-1281.
Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery 2015, , New York.
Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits 2013, New York.
Mentz, G., Schulz, A.J., Mukherjee, B., Ragunathan, T.E., Perkins, D.W. & Israel, B.A. 2012, “Hypertension: Development of a prediction model to adjust self-reported hypertension prevalence at the community level”, BMC Health Services           Research, vol. 12, pp. 312.
Nguyen, H. V. (2016). Keeping up with the joneses: Neighbourhood wealth and hypertension. Journal of Happiness Studies, 17(3), 1255-1271. doi:https://dx.doi.org/10.1007/s10902-015-9641-9
Portal Hypertension Therapeutics – Pipeline Assessment and Market Forecasts to 2019 2012, New York.
Research and Markets: Pulmonary Arterial Hypertension (PAH) Therapeutics – Global Drug Forecasts and Treatment Analysis to 2020 2012, , New York.
Viruell-fuentes, E., Ponce, N.A. & Alegría, M. 2012, “Neighborhood Context and Hypertension Outcomes Among Latinos in Chicago”, Journal of Immigrant and         Minority Health, vol. 14, no. 6, pp. 959-67.
Roberge, S., Giguère, Y., Villa, P., Nicolaides, K., Vainio, M., Forest, J.C., von Dadelzen, P., Vaiman, D., Tapp, S. and Bujold, E., 2012. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. American journal of perinatology, 29(07), pp.551-556.
Strange, G., Keogh, A., Dalton, B. & Gabbay, E. 2011, “Pharmacoeconomic evidence of bosentan for pulmonary arterial hypertension”, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 11, no. 3, pp. 253-63.
Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756 (2010): 1903-1909.

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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

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Question:
Discuss about the Evidence Based Practice for Professional and Clinical Judgment.
 
Answer:

It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014).
There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanner’s model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016).
Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013).
The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013).
The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm.
Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013).
The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014).
The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference between the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013).
 
Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected.
The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors.
Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training to the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014).
Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19.
Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group.
It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received.
Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016).
My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research.
 
References
Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.
Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse Education in Practice, 19, pp.84-90.
Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis. Journal of Marital and Family Therapy, 39(1), pp.17-27.
Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..                                          

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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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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…
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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…
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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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Question:
Discuss about the Evidence Based Practice for Professional and Clinical Judgment.
 
Answer:

It is vital for using short and specific search terms in database search instead of using long sentences for retrieving the appropriate information pertaining to the research question by eliminating the inappropriate hits. The search process becomes much more focused. Using short search terms in different combination makes the search much wider (Panneerselvam 2014).
There is an assumption that evidence-based practice is inflexible and is not successful in establishing relationship with real life experiences. However, evidence alone cannot be considered as sufficient for undertaking evidence-based practice. In this contxt the professional and clinical judgment of health care professionals is necessary for providing an evidence-based approach to care. One must recognise that it is pivotal that all evidence is evaluated effectively before applying in practice. As per Tanner’s model of clinical judgment, a conclusion is to be reached about the concerns, needs and health complications of the patients and then the decision is to be taken regarding the therapeutic approach. Modification of standard approaches might be considered for delivering effective care services. Improving the new approaches would be suitable in order to cater the responses of the patient. This model recognises the preferences of the patients as part of evidence-based practice. The clinical judgement is necessary for determining whether the available evidence can be applied to practice (Nielsen, Lasater and Stock 2016).
Randomised controlled trials and systematic reviews are golden standards of carrying out research studies. Systematic reviews are more significant as compared to a single randomised controlled trial as data from a wide range of sources can be accumulated in a single set and its validity can be then judged. The generalisability of the systematic reviews are more (Oka and Whiting 2013).
The benefit of using randomised control study design for the present study was that such a research methodology would be helpful in determining the cause-effect relationship between self-monitoring and optional decision support and reduction in blood pressure in patients. Random allocation to the intervention group was in addition noteworthy (McKinstry et al. 2013).
The primary outcome was that the mean daytime systolic ambulatory blood pressure fell in both groups, from 146.5 mm Hg to 144.3 mm Hg in the usual care arm and from 146.0 mm Hg to 140.0 mm Hg in the telemonitoring arm. The secondary outcome was that The mean daytime diastolic ambulatory blood pressure also fell in both arms from 85.7 mm Hg to 84.3 mm Hg in the usual care arm and from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm.
Readings for blood pressure was taken every 20 minutes for 14 hours. Blood pressure was measured electronically on both arms in tow phases; first with Stabil-O-Graph device with a proper sized cuff and after providing rest for five minutes, and then using ambulatory blood pressure monitor (McKinstry et al. 2013).
The study was conducted with 401 participants. The sample size is justified as it is large enough to address the research question. For carrying out a randomised control trial, it is necessary to have a large sample size. If the sample size is not large, it is not possible to detect the true differences in outcomes of the study (Matthews and Ross 2014).
The mean difference in daytime systolic ambulatory blood pressure fell between the telemonitoring group and usual care group at six months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This implied that the survey results were reliable. If the procedure was repeated on different samples, the fraction of the calculated confidence intervals encompassing the true population parameter of blood pressure would tends to be 95%. There are 95% chances that the calculated confidence interval of 2.0 to 6.5 from some further experiment would encompass the true value of the population parameter of blood pressure. This takes into consideration the probability related with a confidence interval a point of view prior to the experiment in a similar context in which arguments for the random allocation of the interventions of telemonitoring and usual care are made. The confidence interval is the representation of the value of the population parameter of blood pressure for which the difference between the observed estimate and parameter is not significant in a statistical context (McKinstry et al. 2013).
 
Daytime systolic ambulatory blood pressure between the telemonitoring group and usual care group at 6 months was compared and reported at p=0.0002. When a hypothesis test is performed, the p-value helps in determining the significance of the results. A small p-value of 0.0002 indicated that there was strong evidence against the null hypothesis so that it can be rejected.
The mean daytime diastolic ambulatory pressure fell from 87.4 mm Hg to 83.4 mm Hg in the telemonitoring arm. The difference in mean daytime diastolic ambulatory blood pressure at six months between the two arms was 2.3 mm Hg (95% confidence interval 0.9 to 3.6; P=0.001), adjusted for baseline mean daytime diastolic ambulatory blood pressure and minimisation factors. The small p-value of .0001 implied that there was strong evidence against the null hypothesis so that it can be rejected. The difference in mean surgery measured systolic blood pressure at six months between the two groups was 4.6 mm Hg (95% confidence interval 1.7 to 7.5; P=0.0017) and adjusted for baseline surgery blood pressure and minimisation factors.
Drawing conclusion from the statistical results the telemonitoring could be considered for uncontrolled hypertension for the patients. The statistical significance of the results in high and demonstrates that the results are valid. It was found that management of hypertension in patients at home with the utilisation of telemonitoring application delivered by general practitioners and practice nurses was far more efficient in bringing a reduction in the daytime systolic and diastolic ambulatory blood pressure than was usual care. The average reduction was of statistical significance. However, the costs of the intervention with telemonitoring were higher in comparison to the group with usual care. Therefore it is pivotal that strategies for cost reduction are considered in order to implement the telemonitoring strategy in an effective manner. If costs of implementing telemonitoring are to be sustained effectively, there is a need of mitigating the costs by providing suitable training to the professionals. Caution is to be applied when rolling out telemonitoring at a population level in future (Baker and Tickle-Degnen 2014).
Relative Risk of healing (RR) would be the quotient of the absolute risk of events in the treatment group and the absolute risk of events in the control group. This would be 85/65 that is 1.35. The Absolute Risk Difference (ARD) would be the difference of the absolute risk of events in the control group and the absolute risk of events in the treatment group. This would be 85-65 that is 20. The Numbers Needed to Treat (NNT) would be 1-ARD. This would be 1- 20 that is -19.
Since the RR is 1.35, the events are significantly more likely in the treatment group than the control group. This implies that it is likely that patients getting the bandage B would have better healing of venous leg ulcer. The ARD is 20 percent, and this implies that if 100 patients are teated, 20 patients would be prevented from developing poor outcomes as a result of venous leg ulcer. This implies that this group of the population would be having better healing of venous leg ulcer. The NNT is -19 (approximately 20), and this implies that around five patients would be benefited by the intervention (100/5 = 20). The relative risk of 1.35 is the proportional measure that estimates the size of the effect of the intervention bandage treatment as compared to the control group. It signifies the proportion of bad outcome in the intervention group.
It is not worth using bandage B over bandage A just because the number of patients benefitting from it is comparatively more. A number of factors are to be considered when implementing a new technique. These are to include stability and reliability of the bandage to be used, accessibility of the product, concerns and attitudes of the healthcare professionals towards using the new product, support and training provided and complete a range of benefits received.
Healthcare providers are often faced with challenges and barriers in successfully applying research evidence into their daily clinical practice. These encompass the complexity of of the research, organisational barriers, difficulties in development of policy based on the evidence and difficulties in application of the new research findings due to low patient adherance to the new intervention (Hall and Roussel 2016).
My learning experience in this subject would guide me to prepare my role as a junior clinican in future. With adequate knowledge of application of research findings into practice, I would be able to improve the efficiency and quality of the services I would provide. Revised methods for treatment would be better constructed on the basis of the best evdiecnes. A patient-centric approach would be provided through my practice. This would promote health outcomes for the patients and eventually improve the quality of services delivered. The healthcare organisation I would work in would receive the potential financial value benefits and returns on investment on research.
 
References
Baker, N. and Tickle-Degnen, L., 2014. Evidence-based practice. Willard and Spackman’s occupational therapy, 12th edn. Lippincott, Philadelphia, pp.398-412.
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Matthews, B. and Ross, L., 2014. Research methods. Pearson Higher Ed.
McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.
Nielsen, A., Lasater, K. and Stock, M., 2016. A framework to support preceptors’ evaluation and development of new nurses’ clinical judgment. Nurse Education in Practice, 19, pp.84-90.
Oka, M. and Whiting, J., 2013. Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic, and sequential analysis. Journal of Marital and Family Therapy, 39(1), pp.17-27.
Panneerselvam, R., 2014. Research methodology. PHI Learning Pvt. Ltd..                                          

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NR510 Leadership And Role Of The Advanced Practice Nurse
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Answer:
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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CNA741 Foundations Of Mental Health Nursing Theory 2
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Course Code: CNA741
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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…
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NUR2107 Person Centered Mental Health Care
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Course Code: NUR2107
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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…
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ITC542 Internetworking With TCP/IP
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Course Code: ITC542
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1.
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:
With good transferring of the time sensitive data like the audio or the video.
The suit for the multiplexing.
2.
CSMA/CD is set with the operations wi…
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NURS11159 Introduction To Nursing
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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
University: Griffith University

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Question:
Discuss about the NuHypertensive Patients.
 
 
Answer:
Introduction

High blood pressure is a health condition that is related to abnormal functioning of the heart. The heart uses too much energy to force blood through the blood vessels, that is, arteries and veins. This further hardens the blood vessels thus making more hard for the blood to go through easily. It can be referred to as a condition whereby the heart pumps blood at a high rate and speed than the normal recommended rate. This is a fatal health problem that must be dealt with as soon as possible the moment it is noticed, else it may lead to death of the victim. The condition is caused by several factors, most of which are caused by human activities or lifestyle. Medical research shows that majority of heart related ailments start as a result of the food eaten by people, the lifestyle they are having, and so many other human activities. However, research indicates that high blood pressure is a manageable condition and the patient can still live the normal lifestyle they had before the attack commenced. If they follow the prescribed measures given to them by the doctors without fail, then there are high chances that the hypertension condition will cease to exist and the patient will go back to his or her normal life condition. The lowest reading of blood pressure is diastolic, which the blood pressure rate must not go below. Blood pressure has also the highest reading called systolic, which is also fatal if the pressure rate exceeds. Abnormal blood pressure is caused by among other things; smoking, stress, genetics, being obese, eating too much salt in foods. Sleep apnea and many other.
Hypertensive Patients
Hypertension is one of the circulatory disorders that affect majority of people in the world currently. Medical statistics have revealed shocking figures about the number of people suffering from hypertension in the world. One out of every three people who were interviewed have hypertension symptoms or suffered from the condition previously. According to the statistics, men of a certain age group are the most likely to be affect compared to their women counterparts (Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth, 2012). However, we are informed that at some point, both the gender suffers the same fate. This is due to the fact that the circulation system of older people functions almost the same way and at the same rate. This is attributed to the fact that majority of these people have blood pressure rate higher than 140/90 mm Hg, which according to the medics, is very high and can easily lead to heart failure and other heart related illnesses (Esler, et al, 2008). The following are signs and symptoms characterised by hypertension:

Headrace
Sleepiness
Comma
Confusion
Severe headache.
Fatigue or confusion.
Vision problems.
Chest pain.
Difficulty breathing.
Irregular heartbeat.
Blood in the urine.
Pounding in your chest, ears, neck, etc.

 
Hypertensive patients can manage the condition by visiting medical facilities and getting professional advice and treatment from qualified medical personnel. The treatment involves drugs administration and change of lifestyle as well (Gallego, et al, 2013). Doctors address that the first step towards hypertension treatment and management is change of lifestyle. Lifestyles of individuals affects the levels of BP. Research indicates that a decrease the levels of BP concentration by as little as 2 mm Hg is able to lower the chances of heart attack by close to 15% and as well reduce the risks of getting artery related coronary diseases or infections by close to between 6% and 7% in a community setup. The patients are advised to do enough physical exercises. They are also required to eat the foods that aid in healing of blood vessels and their proper growth as well as healing. Smoking cigarette hardens the walls of arteries in the body thus making it hard for blood to flow easily. This causes the heart to pump blood using excessive force which leads to heart attack. Hypertension has also been characterised by too much intake of alcohol (Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension, 2012). It, therefore, means that everyone within the community setup should take less of alcoholic beverages or avoid it altogether for a better functioning heart, which means that the rate of blood pressure will be normal. Hypertensive patients also need to reduce the overall body weight. Australian medical journal indicates clearly that obese people are at a higher risk of suffering from hypertension as compared to their non-obese counterparts (Global Hypertension Market and Competitive Landscape, 2016). This is because the heart uses too much energy to push blood to the entire body of the overweight person, thus making the hear become fatigue at later lead to hypertension.
Doctors can also use medical procedures to help treat hypertension. However, the type of drugs they (doctors) give depends on a number of factor. First, they need to know the causes of the hypertension, they will monitor the medical history of the patients to know what other health problems the patient is suffering from. the doctor may then give the patient anti-hypertensive drugs which will also reduce hypertension and its effects. Doctors do give ‘water pills’, which are also referred to as diuretics (Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets, 2016). Diuretics are used to make the kidneys work harder to remove excessive salt and water from the body. This is done because the body does not have enough water so removal of excess salt means that the body will not need more water to neutralize the salty contents. Another medicine administered is called better-blocker. These medicines are generally used to slow down the rate of heart beat and also – prevent the heart from squeezing and un-squeezing very hard. Thus reducing the energy needed to pump blood while also making the blood flow using much reduced force (Gu & Dong, 2016).
 
Amlodipine
This is another method used to treat and manage hypertension, also known as high blood pressure. It should be remembered that a low blood pressure prevents the victim patient from contacting more diseases such as kidney problems, stroke, heart attack and other related ailments. Amlodipine is used by medics to relax blood vessel such as veins and arteries. The drug is administered to the hypertensive patient so that the pumped blood from the heart can go through the vessels with much ease. Medical reports also reveal that people who suffer from hypertension experience a certain level of chest pain, a medical condition known as angina (Keogh & Wlodarczyk, 2004). Apart from relaxing blood vessels, amlodipine is also used to prevent angina. The drug is used to boost the patient’s ability to do physical exercises, which goes hand in hand to preventing hypertension. When administered, amlodipine also reduces the rate at which the chest pain occurs. This will make the patient have more easy and relaxed time thus making him or her feel better. However, the doctors warn that amlodipine is only for reducing the chest pain felt by hypertensive patient and should not be used for treatment purposes (Keogh, 2011).
Amlodipine is administered via mount. Others may prefer to take the medicine alongside food or without. But this must only be according to the prescriptions given by the doctor and not a self-choice. It always preferred to be taken only once every day for it to be effective and not to bring more harm to the patient. However, the full dosage given by the medical personnel depends on several factors including response of the patient to the drugs given so far and the condition of the patient medically. Amlodipine must be taken regularly in order for it to have best effect in the body (Krum, 2009). Medics also say that it is important to take the medicine at the same time daily to avoid forgetting and possible skips. Patients are required to continue taking amlodipine even after. The feel that they are now fine and free from hypertension. This is because a higher percentage of hypertensive patient do not have a strong feeling of being sick and so they might misinterpret their condition and stop the treatment. The following are other uses of amlodipine and what is treats;

Hypertension medications
Angina prevention
Other types of angina, for instance cases where chest pains are very strong
Chronic medication which, those that show characteristics of angina.  

Chlorthalidone
This is a medical tablet used to treat hypertension. Just like amlodipine, chlorthalidone is used to get excess water that is not needed by the body and excess salt out of the body through urine. Chlorthalidone is taken as a pill after food and should not be taken without eating (Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery, 2015). This is because of its side effects to the patient. Medical personnel warn that in order to maximize its functionality in the body, chlorthalidone should be taken every once every day as prescribed by the physician. According to research, the drug maximizes its effects in the body when taken during morning hours as compared to other times of the day. This, therefore, mean that the drug should be taken immediately after breakfast every day. We are informed that chlorthalidone only controls the blood pressures of people but does not cure such ailments. In addition to that, the patients are advised to continue taking the same even if they feel like they need not to take the medicine anymore (Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits, 2013). It is only the doctor who administered the drug can recommend whether to stop it or not. The drug is also used to cure people who are suffering from diabetes insipidus. In addition to that, chlorthalidone also prevents kidney stones, which is most prevalent to patients with calcium in blood. Scholarly information describes that women who are pregnant should not attempt the usage of chlorthalidone, unless it is absolutely necessary to do so (Mentz, et al, 2012). This is because the drug in question causes suppression of milk production in pregnant women, thus may make it difficult to breast feed the infants. The following are the effects of chlorthalidone to the patient taking it;

It causes reduction in potassium and magnesium in the patient’s body.
Increase the levels of uric acid in the human body.
After taking the drug, the patient light-headedness and dizziness as well.
It causes prolonged headache to patients.
The patient faces frequent vomiting most of the time.
Fatigue, after small amount of physical work.
The patient also feels abdominal pain. Others include but not limited to; fever, breathing difficulties, severe rushes with skin peel off.

 
Coronary artery diseases (CAD)
This is the most prevalent type of hart related diseases and affects majority of people in Australia. The disease is caused by atherosclerosis and leads to blockage of blood flow to the heart (Nguyen, 2016). Depending on the level of infection, the patient may become asymptomatic until when thrombosis occurs. Research indicates that coronary artery diseases are the leading resinous causes of death nowadays in Australia. The statistics produced by the world health organisation indicates that in every seven people in Australia, at least one has had coronary attack before or is currently suffering from heart related attack (Portal Hypertension Therapeutics, 2012). During diagnosis, the physician will first assess the patient and know his or her medical history and to also known the period which the patient has suffered from this illness. The following is a list of diagnosis procedures that they doctor may carry out.

Electrocardiogram – this is a type of diagnosis whereby electric signals are recorded as they travel to the heart. The process helps the doctor know whether the patient suffered any form of heart attack previously or is in the process, thus giving proper medication. The exercise involves a patient wearing a portable monitor like apparatus from close to 24 hours, thus recording the needed results (Viruell-fuentes, Ponce & Alegría, 2012).
Echocardiogram – this is a machine that uses sound waves to produce graphical images of the heart of the patient. This helps to know whether the entire heart is working towards pumping enough blood to other body parts or not. Research reveals that the parts of the heart that do not contribute immensely toward better operation of the heart may mean signs of heart attack or lower oxygen in those parts (Robergeet al, 2012). This, therefore, shows signs of coronary artery to the heart or other heart related problems.
Stress tests – this method is used mostly when the patient displays sign of coronary artery disease when doing physical activity. At some point, the physician may be forced to use some types of medication instead of physical exercise depending on the level of heart infection and the overall ability of the patent. Flow of blood towards the heart vessels during hours of rest and stressful time can also be taken, a process called nuclear stress test (Strange, et al, 2011). This is whereby a tracer like object, which have got special types of cameras, is injected in the blood stream of the patient. This tracer is, therefore, able to identify specific areas of the heart where there is no enough flow of blood.
Angiogram – the doctor injects a special type of a dye in the coronary arteries. The dye is thin but long tube called catheter. It goes through one of the arteries in the leg straight to the arteries found in the heart. Once it identifies a blockage in the blood vessel where treatment is possibly required, a special type of a balloon is then inflated in to the walls of the artery via the catheter. This widens the arteries thus increasing flow of blood. A mesh, called a stent, is then to continuously keep such an artery open for a specific period of time.
Heart scan – doing computerised heart scans helps the medical personnel know whether the arteries of the heart are blocked or no.

 
Treatment of Coronary Artery Diseases
The most preferred treatment method of CAD is a change in the lifestyle of the patients and the general community (Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756, 2010). People who have been diagnosed with CAD need to do the following to help improve their health standards;

Quit smoking (both active smoking and passive smoking).
Eat healthy foods and balanced diet.
Exercise regularly.
Lose excess weight, through physical exercises.
Reduce stress.

Drugs can also be used to treat or better manage coronary artery diseases as well.
Conclusion
Hypertension is a disease that is associated with malfunctioning of the heart. The heart fails to operate in the normal way as needed for better functioning of the entire body mechanism. Reports indicate that a better number of people living in Australia suffer from this heart condition due to their own lifestyles. Better and healthy living is obtained through change of lifestyle. Research shows that is people change the types of food they eat to include balanced diet and natural vegetables and fruits, then chances of getting hypertension will be reduced by a very high percentage. Amlodipine and chlorthalidone are seen as the most used scientific methods of treating and managing high blood pressure. Both the methods almost work the same, even though doctors who handle hypertensive patients revel that majority of them prefer amlodipine to chlorthalidone because of its less side effects as compared to the later. Australian department of medical research states that majority of its citizens have shown improvement and reduction in rate of hypertension attached. This is attributed to the public knowhow that have been carried out in the entire country, enlightening the dangers of hypertension. During treatment of hypertension, doctors first administer small amount of medication to the patient. After monitoring the healing progress of such a patient, the doctor may decide to continue with more advanced treatments. Patients are then required to follow all the prescriptions given by the doctor strictly so that hypertension conditions can heal much faster. Skipping any of the prescribed medication may lead to a worsening condition and probably more dangers. Doing this also prolongs the healing periods.
 
References
Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth2012, , New York.
Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L. and Brenchley, C., 2008. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clinical and Experimental Pharmacology and Physiology, 35(4), pp.498-502.
Gallego, B., Runciman, W.B., Perez-Concha, O., Liaw, S., Day, R.O., Dunn, A.G. & Coiera, E. 2013, “The management of severe hypertension in Australian general practice”, BMC Health Services Research, vol. 13, pp. 414.
Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension 2012, , New York.
Global Hypertension Market and Competitive Landscape Highlights 2016 – Research and Markets 2016, , New York.
Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets 2016, , New York.
Gu, S., Hu, H. & Dong, H. 2016, “Systematic Review of the Economic Burden of Pulmonary Arterial Hypertension”, PharmacoEconomics, vol. 34, no. 6, pp. 533-550.
Keogh, A. & Wlodarczyk, J. 2004, “Idiopathic- and scleroderma-related pulmonary arterial hypertension: outcomes and QOL on bosentan”, Expert Review of      Pharmacoeconomics & Outcomes Research, vol. 4, no. 5, pp. 505-13.
Keogh, A., Strange, G., McNeil, K., Williams, T.J., Gabbay, E., Proudman, S., Weintraub, R.G., Wlodarczyk, J. and DAlton, B., 2011. The bosentan patient registry: long?term survival in pulmonary arterial hypertension. Internal medicine journal, 41(3), pp.227-234.
Krum, H., Schlaich, M., Whitbourn, R., Sobotka, P.A., Sadowski, J., Bartus, K., Kapelak, B., Walton, A., Sievert, H., Thambar, S. and Abraham, W.T., 2009. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. The Lancet, 373(9671), pp.1275-1281.
Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery 2015, , New York.
Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits 2013, New York.
Mentz, G., Schulz, A.J., Mukherjee, B., Ragunathan, T.E., Perkins, D.W. & Israel, B.A. 2012, “Hypertension: Development of a prediction model to adjust self-reported hypertension prevalence at the community level”, BMC Health Services           Research, vol. 12, pp. 312.
Nguyen, H. V. (2016). Keeping up with the joneses: Neighbourhood wealth and hypertension. Journal of Happiness Studies, 17(3), 1255-1271. doi:https://dx.doi.org/10.1007/s10902-015-9641-9
Portal Hypertension Therapeutics – Pipeline Assessment and Market Forecasts to 2019 2012, New York.
Research and Markets: Pulmonary Arterial Hypertension (PAH) Therapeutics – Global Drug Forecasts and Treatment Analysis to 2020 2012, , New York.
Viruell-fuentes, E., Ponce, N.A. & Alegría, M. 2012, “Neighborhood Context and Hypertension Outcomes Among Latinos in Chicago”, Journal of Immigrant and         Minority Health, vol. 14, no. 6, pp. 959-67.
Roberge, S., Giguère, Y., Villa, P., Nicolaides, K., Vainio, M., Forest, J.C., von Dadelzen, P., Vaiman, D., Tapp, S. and Bujold, E., 2012. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. American journal of perinatology, 29(07), pp.551-556.
Strange, G., Keogh, A., Dalton, B. & Gabbay, E. 2011, “Pharmacoeconomic evidence of bosentan for pulmonary arterial hypertension”, Expert Review of Pharmacoeconomics & Outcomes Research, vol. 11, no. 3, pp. 253-63.
Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756 (2010): 1903-1909.

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Question:
Discuss about the NuHypertensive Patients.
 
 
Answer:
Introduction

High blood pressure is a health condition that is related to abnormal functioning of the heart. The heart uses too much energy to force blood through the blood vessels, that is, arteries and veins. This further hardens the blood vessels thus making more hard for the blood to go through easily. It can be referred to as a condition whereby the heart pumps blood at a high rate and speed than the normal recommended rate. This is a fatal health problem that must be dealt with as soon as possible the moment it is noticed, else it may lead to death of the victim. The condition is caused by several factors, most of which are caused by human activities or lifestyle. Medical research shows that majority of heart related ailments start as a result of the food eaten by people, the lifestyle they are having, and so many other human activities. However, research indicates that high blood pressure is a manageable condition and the patient can still live the normal lifestyle they had before the attack commenced. If they follow the prescribed measures given to them by the doctors without fail, then there are high chances that the hypertension condition will cease to exist and the patient will go back to his or her normal life condition. The lowest reading of blood pressure is diastolic, which the blood pressure rate must not go below. Blood pressure has also the highest reading called systolic, which is also fatal if the pressure rate exceeds. Abnormal blood pressure is caused by among other things; smoking, stress, genetics, being obese, eating too much salt in foods. Sleep apnea and many other.
Hypertensive Patients
Hypertension is one of the circulatory disorders that affect majority of people in the world currently. Medical statistics have revealed shocking figures about the number of people suffering from hypertension in the world. One out of every three people who were interviewed have hypertension symptoms or suffered from the condition previously. According to the statistics, men of a certain age group are the most likely to be affect compared to their women counterparts (Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth, 2012). However, we are informed that at some point, both the gender suffers the same fate. This is due to the fact that the circulation system of older people functions almost the same way and at the same rate. This is attributed to the fact that majority of these people have blood pressure rate higher than 140/90 mm Hg, which according to the medics, is very high and can easily lead to heart failure and other heart related illnesses (Esler, et al, 2008). The following are signs and symptoms characterised by hypertension:

Headrace
Sleepiness
Comma
Confusion
Severe headache.
Fatigue or confusion.
Vision problems.
Chest pain.
Difficulty breathing.
Irregular heartbeat.
Blood in the urine.
Pounding in your chest, ears, neck, etc.

 
Hypertensive patients can manage the condition by visiting medical facilities and getting professional advice and treatment from qualified medical personnel. The treatment involves drugs administration and change of lifestyle as well (Gallego, et al, 2013). Doctors address that the first step towards hypertension treatment and management is change of lifestyle. Lifestyles of individuals affects the levels of BP. Research indicates that a decrease the levels of BP concentration by as little as 2 mm Hg is able to lower the chances of heart attack by close to 15% and as well reduce the risks of getting artery related coronary diseases or infections by close to between 6% and 7% in a community setup. The patients are advised to do enough physical exercises. They are also required to eat the foods that aid in healing of blood vessels and their proper growth as well as healing. Smoking cigarette hardens the walls of arteries in the body thus making it hard for blood to flow easily. This causes the heart to pump blood using excessive force which leads to heart attack. Hypertension has also been characterised by too much intake of alcohol (Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension, 2012). It, therefore, means that everyone within the community setup should take less of alcoholic beverages or avoid it altogether for a better functioning heart, which means that the rate of blood pressure will be normal. Hypertensive patients also need to reduce the overall body weight. Australian medical journal indicates clearly that obese people are at a higher risk of suffering from hypertension as compared to their non-obese counterparts (Global Hypertension Market and Competitive Landscape, 2016). This is because the heart uses too much energy to push blood to the entire body of the overweight person, thus making the hear become fatigue at later lead to hypertension.
Doctors can also use medical procedures to help treat hypertension. However, the type of drugs they (doctors) give depends on a number of factor. First, they need to know the causes of the hypertension, they will monitor the medical history of the patients to know what other health problems the patient is suffering from. the doctor may then give the patient anti-hypertensive drugs which will also reduce hypertension and its effects. Doctors do give ‘water pills’, which are also referred to as diuretics (Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets, 2016). Diuretics are used to make the kidneys work harder to remove excessive salt and water from the body. This is done because the body does not have enough water so removal of excess salt means that the body will not need more water to neutralize the salty contents. Another medicine administered is called better-blocker. These medicines are generally used to slow down the rate of heart beat and also – prevent the heart from squeezing and un-squeezing very hard. Thus reducing the energy needed to pump blood while also making the blood flow using much reduced force (Gu & Dong, 2016).
 
Amlodipine
This is another method used to treat and manage hypertension, also known as high blood pressure. It should be remembered that a low blood pressure prevents the victim patient from contacting more diseases such as kidney problems, stroke, heart attack and other related ailments. Amlodipine is used by medics to relax blood vessel such as veins and arteries. The drug is administered to the hypertensive patient so that the pumped blood from the heart can go through the vessels with much ease. Medical reports also reveal that people who suffer from hypertension experience a certain level of chest pain, a medical condition known as angina (Keogh & Wlodarczyk, 2004). Apart from relaxing blood vessels, amlodipine is also used to prevent angina. The drug is used to boost the patient’s ability to do physical exercises, which goes hand in hand to preventing hypertension. When administered, amlodipine also reduces the rate at which the chest pain occurs. This will make the patient have more easy and relaxed time thus making him or her feel better. However, the doctors warn that amlodipine is only for reducing the chest pain felt by hypertensive patient and should not be used for treatment purposes (Keogh, 2011).
Amlodipine is administered via mount. Others may prefer to take the medicine alongside food or without. But this must only be according to the prescriptions given by the doctor and not a self-choice. It always preferred to be taken only once every day for it to be effective and not to bring more harm to the patient. However, the full dosage given by the medical personnel depends on several factors including response of the patient to the drugs given so far and the condition of the patient medically. Amlodipine must be taken regularly in order for it to have best effect in the body (Krum, 2009). Medics also say that it is important to take the medicine at the same time daily to avoid forgetting and possible skips. Patients are required to continue taking amlodipine even after. The feel that they are now fine and free from hypertension. This is because a higher percentage of hypertensive patient do not have a strong feeling of being sick and so they might misinterpret their condition and stop the treatment. The following are other uses of amlodipine and what is treats;

Hypertension medications
Angina prevention
Other types of angina, for instance cases where chest pains are very strong
Chronic medication which, those that show characteristics of angina.  

Chlorthalidone
This is a medical tablet used to treat hypertension. Just like amlodipine, chlorthalidone is used to get excess water that is not needed by the body and excess salt out of the body through urine. Chlorthalidone is taken as a pill after food and should not be taken without eating (Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery, 2015). This is because of its side effects to the patient. Medical personnel warn that in order to maximize its functionality in the body, chlorthalidone should be taken every once every day as prescribed by the physician. According to research, the drug maximizes its effects in the body when taken during morning hours as compared to other times of the day. This, therefore, mean that the drug should be taken immediately after breakfast every day. We are informed that chlorthalidone only controls the blood pressures of people but does not cure such ailments. In addition to that, the patients are advised to continue taking the same even if they feel like they need not to take the medicine anymore (Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits, 2013). It is only the doctor who administered the drug can recommend whether to stop it or not. The drug is also used to cure people who are suffering from diabetes insipidus. In addition to that, chlorthalidone also prevents kidney stones, which is most prevalent to patients with calcium in blood. Scholarly information describes that women who are pregnant should not attempt the usage of chlorthalidone, unless it is absolutely necessary to do so (Mentz, et al, 2012). This is because the drug in question causes suppression of milk production in pregnant women, thus may make it difficult to breast feed the infants. The following are the effects of chlorthalidone to the patient taking it;

It causes reduction in potassium and magnesium in the patient’s body.
Increase the levels of uric acid in the human body.
After taking the drug, the patient light-headedness and dizziness as well.
It causes prolonged headache to patients.
The patient faces frequent vomiting most of the time.
Fatigue, after small amount of physical work.
The patient also feels abdominal pain. Others include but not limited to; fever, breathing difficulties, severe rushes with skin peel off.

 
Coronary artery diseases (CAD)
This is the most prevalent type of hart related diseases and affects majority of people in Australia. The disease is caused by atherosclerosis and leads to blockage of blood flow to the heart (Nguyen, 2016). Depending on the level of infection, the patient may become asymptomatic until when thrombosis occurs. Research indicates that coronary artery diseases are the leading resinous causes of death nowadays in Australia. The statistics produced by the world health organisation indicates that in every seven people in Australia, at least one has had coronary attack before or is currently suffering from heart related attack (Portal Hypertension Therapeutics, 2012). During diagnosis, the physician will first assess the patient and know his or her medical history and to also known the period which the patient has suffered from this illness. The following is a list of diagnosis procedures that they doctor may carry out.

Electrocardiogram – this is a type of diagnosis whereby electric signals are recorded as they travel to the heart. The process helps the doctor know whether the patient suffered any form of heart attack previously or is in the process, thus giving proper medication. The exercise involves a patient wearing a portable monitor like apparatus from close to 24 hours, thus recording the needed results (Viruell-fuentes, Ponce & Alegría, 2012).
Echocardiogram – this is a machine that uses sound waves to produce graphical images of the heart of the patient. This helps to know whether the entire heart is working towards pumping enough blood to other body parts or not. Research reveals that the parts of the heart that do not contribute immensely toward better operation of the heart may mean signs of heart attack or lower oxygen in those parts (Robergeet al, 2012). This, therefore, shows signs of coronary artery to the heart or other heart related problems.
Stress tests – this method is used mostly when the patient displays sign of coronary artery disease when doing physical activity. At some point, the physician may be forced to use some types of medication instead of physical exercise depending on the level of heart infection and the overall ability of the patent. Flow of blood towards the heart vessels during hours of rest and stressful time can also be taken, a process called nuclear stress test (Strange, et al, 2011). This is whereby a tracer like object, which have got special types of cameras, is injected in the blood stream of the patient. This tracer is, therefore, able to identify specific areas of the heart where there is no enough flow of blood.
Angiogram – the doctor injects a special type of a dye in the coronary arteries. The dye is thin but long tube called catheter. It goes through one of the arteries in the leg straight to the arteries found in the heart. Once it identifies a blockage in the blood vessel where treatment is possibly required, a special type of a balloon is then inflated in to the walls of the artery via the catheter. This widens the arteries thus increasing flow of blood. A mesh, called a stent, is then to continuously keep such an artery open for a specific period of time.
Heart scan – doing computerised heart scans helps the medical personnel know whether the arteries of the heart are blocked or no.

 
Treatment of Coronary Artery Diseases
The most preferred treatment method of CAD is a change in the lifestyle of the patients and the general community (Symplicity HTN-2 Investigators. “Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial.” The Lancet 376, no. 9756, 2010). People who have been diagnosed with CAD need to do the following to help improve their health standards;

Quit smoking (both active smoking and passive smoking).
Eat healthy foods and balanced diet.
Exercise regularly.
Lose excess weight, through physical exercises.
Reduce stress.

Drugs can also be used to treat or better manage coronary artery diseases as well.
Conclusion
Hypertension is a disease that is associated with malfunctioning of the heart. The heart fails to operate in the normal way as needed for better functioning of the entire body mechanism. Reports indicate that a better number of people living in Australia suffer from this heart condition due to their own lifestyles. Better and healthy living is obtained through change of lifestyle. Research shows that is people change the types of food they eat to include balanced diet and natural vegetables and fruits, then chances of getting hypertension will be reduced by a very high percentage. Amlodipine and chlorthalidone are seen as the most used scientific methods of treating and managing high blood pressure. Both the methods almost work the same, even though doctors who handle hypertensive patients revel that majority of them prefer amlodipine to chlorthalidone because of its less side effects as compared to the later. Australian department of medical research states that majority of its citizens have shown improvement and reduction in rate of hypertension attached. This is attributed to the public knowhow that have been carried out in the entire country, enlightening the dangers of hypertension. During treatment of hypertension, doctors first administer small amount of medication to the patient. After monitoring the healing progress of such a patient, the doctor may decide to continue with more advanced treatments. Patients are then required to follow all the prescriptions given by the doctor strictly so that hypertension conditions can heal much faster. Skipping any of the prescribed medication may lead to a worsening condition and probably more dangers. Doing this also prolongs the healing periods.
 
References
Epidemiology: Hypertension – Rising with Increasing Obesity and Population Growth2012, , New York.
Esler, M., Eikelis, N., Schlaich, M., Lambert, G., Alvarenga, M., Dawood, T., Kaye, D., Barton, D., Pier, C., Guo, L. and Brenchley, C., 2008. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clinical and Experimental Pharmacology and Physiology, 35(4), pp.498-502.
Gallego, B., Runciman, W.B., Perez-Concha, O., Liaw, S., Day, R.O., Dunn, A.G. & Coiera, E. 2013, “The management of severe hypertension in Australian general practice”, BMC Health Services Research, vol. 13, pp. 414.
Global Hypertension Experts Launch First-of-its-Kind Online Resource to Help Healthcare Professionals Address Most Challenging Form of Hypertension 2012, , New York.
Global Hypertension Market and Competitive Landscape Highlights 2016 – Research and Markets 2016, , New York.
Global Hypertension Market and Competitive Landscape 2015-2020 – Research and Markets 2016, , New York.
Gu, S., Hu, H. & Dong, H. 2016, “Systematic Review of the Economic Burden of Pulmonary Arterial Hypertension”, PharmacoEconomics, vol. 34, no. 6, pp. 533-550.
Keogh, A. & Wlodarczyk, J. 2004, “Idiopathic- and scleroderma-related pulmonary arterial hypertension: outcomes and QOL on bosentan”, Expert Review of      Pharmacoeconomics & Outcomes Research, vol. 4, no. 5, pp. 505-13.
Keogh, A., Strange, G., McNeil, K., Williams, T.J., Gabbay, E., Proudman, S., Weintraub, R.G., Wlodarczyk, J. and DAlton, B., 2011. The bosentan patient registry: long?term survival in pulmonary arterial hypertension. Internal medicine journal, 41(3), pp.227-234.
Krum, H., Schlaich, M., Whitbourn, R., Sobotka, P.A., Sadowski, J., Bartus, K., Kapelak, B., Walton, A., Sievert, H., Thambar, S. and Abraham, W.T., 2009. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. The Lancet, 373(9671), pp.1275-1281.
Mallinckrodt’s INOmax(R) Approved In Australia And Japan For Pulmonary Hypertension In Conjunction With Heart Surgery 2015, , New York.
Media Alert – Salt Storm! Hypertension Canada gathers experts to debate sodium limits 2013, New York.
Mentz, G., Schulz, A.J., Mukherjee, B., Ragunathan, T.E., Perkins, D.W. & Israel, B.A. 2012, “Hypertension: Development of a prediction model to adjust self-reported hypertension prevalence at the community level”, BMC Health Services           Research, vol. 12, pp. 312.
Nguyen, H. V. (2016). Keeping up with the joneses: Neighbourhood wealth and hypertension. Journal of Happiness Studies, 17(3), 1255-1271. doi:https://dx.doi.org/10.1007/s10902-015-9641-9
Portal Hypertension Therapeutics – Pipeline Assessment and Market Forecasts to 2019 2012, New York.
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