Category: Health & Medicine

Windshield Survey of Palatine City

The windshield survey was conducted on the west side of Palatine on Sunday, November 1^st at 4 p.m. The temperature was 60F, and it was sunny and cold. The boundaries of the neighborhood included Quentin Road, Euclid Avenue, Smith Road, and Dundee Road; the whole area is residential. While driving I saw a wooden plate with the citys name in Dundee and Quentin, and flags on the light poles along Quentin Road, which made it easier to coordinate.

The majority of the houses that I met are about 30-40 years old. Some of them have new constructions. Mostly I observe single houses that have two stories, but there are also ranges of houses. Moreover, there are new three apartment buildings on the crossroad of Quentin and Palatine Roads. Everything is made of brick. Between the houses, there are well-grounded spaces with flower gardens. To my mind, the houses are in a good condition. They are very well maintained and seem to be new ones. I have noticed no signs of despair.

There are cars in the driveways. As it is Sunday, there is a high possibility that people are not working and have a day-off. So it is not surprising that they are outside, and kids are playing near. I observed no vacant houses, so believe that all of them are occupied. There are no boarded up and dilapidated buildings as well as those for sale. I also saw well-maintained sidewalks and drainages and curbs that look clean and open.

There are lots of open spaces for parks opened for the general public (I observed at least 5). I saw no trash and abandoned cars there; instead, they have playgrounds and golf courses, bike paths, and walking paths as well as small lakes. There are light poles on the major paths and around playgrounds. Moreover, there are two recreational areas: Birchwood and Hamilton.

I saw a big shopping center with the European grocery store, Walgreens, US bank, laundry, Seven-Eleven, Italian restaurant, Vitamin store, subway, woman care center, McDonalds, and Pancake house in the middle of the community. A smaller shopping center is located about 2 miles south of the first one with a Goodwill donation center, two banks, a nail salon Walgreens, Sushi Bistro, Jimmy Johns, and a driving school. As I was driving I have noticed one more Seven-Eleven store, Subway, and Thai Cuisine on the small plaza on Smith Road. Thus, the resources cluster in shopping areas. I observed no ethnic stores that display other than the English language. Even though the European grocery store has products from Europe as well as those locally produced, everything is given in the English language. I have also noticed no tobacco and alcohol stores.

There are many public schools in the neighborhood. They include Pleasant Hill Elementary School, Walter Sundling Middle School, Northwest Suburban Special Education School, Todays Child Learning Center (daycare), and William Fremd High School. Play areas and sports fields are connected to them. I have noticed no graffiti, and the school grounds appear to be very well-kept. There are school bus stops and crossing guards with blinking signs even though it is Sunday.

The religion is presented by different churches such as Korean Bethel Presbyterian Church, Resurrection Orthodox Church, Second-Baptist Church, and Countryside Church Unitarian Universalist. I also noticed the signs for Sunday religious school for kids on the first two, which proves that they are targeted at the community.

I was looking for human services but saw only Womans care center. I think that they use the Walgreens minute clinics located on Northwest Highway and Euclid Avenue. I noticed Alexian Brothers Immediate care center is 5 miles away on Northwest Highway and Northwest Community Hospital in Arlington Heights is 10 minutes away. I saw two offices of CVS pharmacy clinic on Smith and Northwest highways but no alternative medicine centers. Moreover, I noticed a food party in the Palatine Township Bridge and a daycare for low-income families. There is Palatine Senior Center on Quentin Road and Todays Child Learning Center and daycare in Township center.

As I saw people get in and out mostly with cars. I have noticed several bus stops but no buses during the time spent in the neighborhood. There was also a metro sign, but the station is not there. It appears that Quentin Road and Euclid Road were paved this summer, and some parts of Smith Road were still under reconstruction during the survey. It is a high traffic area because the streets lead to highway 190 and major commercial areas. I saw speed limits signs and speed zones in front of the schools.

Projective services include the fire department (2 miles away) and the police department (5 miles away). The community looks safe. Police cars are rounding around the small streets and fire hydrants are everywhere. Half of the bigger houses have security systems, and there is a tornado shelter in the Township Center. So people who live there feel safe even though they have no neighborhood watch program.

On the streets, I saw elderly people, women, and children. They belong to different ethnic groups (Caucasians, Asians, and Indians) but I noticed no bilingual signs. As I got to know, men usually gather in the golf clubs, and kids at Birchwood residential center. There are social clubs for all ages and sexes (fitness, reading, dance, etc.). As the weather was nice, people spent time communicating with one another. The community seems to be nice and safe, as I saw only a few dogs and no homeless people.

The reason why I have chosen this community is that I had recently moved to another side of Palatine city and wanted to explore this one also. They occurred to be rather different. This one has many strengths, as people look friendly and hospitable, they are ready to help strangers. This and the fact that they are of different nations reduces the number of possible issues during the interaction. Speed limit signs and reconstructed roads and payments make the area safer.

Palatine Township Bridge and Goodwill donation center involve the population in programs that enhance the lives of many people. Unfortunately, the majority of human services are just near the community, which means that the help may come with delay. Hospitals, fire, and police departments are not far away but sometimes even one minute is crucial. The community lacks a neighborhood watch program as well. Still, according to the words of the police officers, they receive the calls only about skunks and squirrels making noise at night. All in all, some improvements may be implemented but generally, the condition of the community has a positive influence on the citizens health.

Extraneous Variables

In the course of the study, one will have to consider a range of extraneous variables. The issues that will have to be controlled include the type of medicine that the participants of the research receive as the means of alleviating pain and the individual pain tolerance levels of the target population. For instance, it will be necessary to make sure that all participants should receive the same medicine for alleviating pain. The amount of drug consumed by each of the participants should also be controlled. Furthermore, the individual perception of pain will have to be addressed so that the participants could have a uniform attitude toward their experience. Age and gender should also be viewed as essential extraneous variables; however, unlike the ability to tolerate pain and the amount of medicine consumed by the target population, the said variables cannot be controlled throughout the research (Becker et al., 2014).

Instruments

Description

The instruments used in the course of the study will allow measuring the participants pain levels successfully. Seeing that pain tolerance levels are individual in each patient and depend on a range of factors, it will be necessary to make the measurement process as objective as possible. For this purpose, two types of assessments will be combined, i.e., numerical (NRS) and verbal rating scales (VRS). The data will be retrieved from the target population based on the information that they provide verbally, as well as their evaluation of pain levels based on a five-point scale (from tolerable to intolerable).

Validity

The validity of the instrument will be tested based on the internal structure of the tool. Particularly, it will be necessary to make sure that the outcomes in patients with pain issues should be evaluated objectively and accurately. Therefore, the changes in NRS and VRS will have to be measured to assure that the validity standards should be met and that the tool can be deemed as a representation of the current high-quality pain measurement devices (Dansie & Turk, 2013).

Reliability

To measure the reliability of the test, one will have to consider its internal consistency (Ravens-Sieberer, Karow, Barthel, & Klasen, 2014). Seeing that the test incorporates the characteristics of two widely acclaimed devices for measuring pain levels in patients, one can posit that the said approach is quite reliable. Using the COSMIN 4-point rating scale, one may also conclude that a combination of the NRS and VRS tools can be considered a rather efficient framework for measuring the patients pain levels (Johnson & Smith, 2017).

Intervention

The use of peer mentoring and self-management as the means of alleviating pain will be utilized as the essential intervention tools. The patients will be provided with detailed instructions about how peer mentoring should be carried out. Furthermore, the participants will be instructed about the ways of managing their pain independently. Thus, further acquisition of the relevant knowledge and skills will be encouraged among the target population (Goldenberg, Payne, Hayes, Zeltzer, & Tsao, 2013).

Data Collection

The information will be gathered with the help of surveys and interviews. As stressed above, the changes in the pain-related experiences are bound to be very subjective because of the individual perception of pain. Thus, it will be crucial to gather the information that will allow for comparatively objective analysis, and interviews can be viewed as the means of exploring the patients in-depth and from the viewpoint of the interviewer.

References

Becker, W. C., Fraenkel, L., Edelman, E. J., Holt, S. R., Glover, J., Kerns, R. D., & Fiellin, D. A. (2014). Instruments to assess patient-reported safety, efficacy or misuse of current opioid therapy for chronic pain: A systematic review. Pain, 154(6), 905916. Web.

Dansie, E. J., & Turk, D. C. (2013). Assessment of patients with chronic pain. British Journal of Anaesthesia, 111(1), 19-25. Web.

Goldenberg, D., Payne, A. L., Hayes, L. P., Zeltzer, L. K., & Tsao, J. C. I. (2013). Peer mentorship teaches social tools for pain self-management: A case study. Journal of Pain Management, 6(1), 61-68.

Johnson, A. M., & Smith, S. M. S. (2017). A review of general pain measurement tools and instruments for consideration of use in COPD clinical practice. International Journal of Chronic Obstructive Pulmonary Disease, 12, 923929. Web.

Ravens-Sieberer, U., Karow, A., Barthel, D., & Klasen, F. (2014). How to assess quality of life in child and adolescent psychiatry. Dialogues in Clinical Neuroscience, 16(2), 147158.

Introduction

Research is an imperative activity aiming to guide nursing practice in providing evidence-based care (Reviriego et al., 2014). Research helps to enhance the quality and efficiency in healthcare, but developing a critical eye for valid research is equally paramount. Critical appraisal of research studies is a determinant factor of decision-making in evidence-based nursing practice. Critical appraisal of research articles is meant to help nurses apply credible knowledge to practice.

The critical appraisal process seeks to determine the validity and representativeness of results. Thereby, the discussion herein takes one through the steps of critically appraising the journal article: Impact of a Fast-Track Esophagectomy Protocol on Esophageal Cancer Patients and Hospital Charges by Jitesh B. Shewale and others published in the 2015 Annals of Surgery. The appraisal process utilizes a critical appraisal tool from the Critical Appraisal Skills Programme (CASP) (2013).

Literature Review

Shewales et al. (2015) article does not have a literature review section and an associated theoretical or conceptual framework. The incorporation of empirical literature occurs in the discussion section, as the authors discuss the results.

Purpose of the Study

The studys objective is clear by merely looking at the title. The title states the population under study, the intervention of focus, and outcomes of interest. On a different note, the title does not meet the requirements if a PICOT question. The title does not indicate a comparator and the duration of the study/intervention. In order to improve surgery outcomes, the study indicates the effectiveness of an FTEP by having a comprehensive look at pertinent outcome measures.

The need for the study is apparent; usually, lengthy hospital stays and high hospital costs are a typical phenomenon after patients undergo esophagectomy and get admitted to the ICU. The FTP entails a modification in the care of esophagectomy patients after surgery. Instead of admission to the ICU after surgery, the new protocol (FTEP) advocates for the transfer of esophagectomy patients to the telemetry unit directly. In addition, the FTEP encourages the inclusion of family and friends in the care of the patient a few hours after esophagectomy. The new protocol yields benefits because of the associated alleviation of both physiological and psychological stress. The study is not intrusive because there is no direct contact with the participants, but the benefits are irrefutable.

Shewales et al. (2015) studys results are a reflection of a cancer medical center; thereby, the results are relevant to similar institutions and population. The results inform practice in cancer departments performing esophagectomy to individuals confirmed with adenocarcinoma or squamous cell carcinoma esophagus (Shewale et al., 2015). Based on the study results, transferring patients directly to the telemetry unit instead of the ICU, immediately after surgery, is more beneficial.

Research Method

In spite of the authors failure to articulate indicate the studys research design, the design qualifies as a quasi-experimental study. The study is retrospective in nature and evaluates the effect of an intervention in two groups. In one group, the fast-track esophagectomy protocol (FTEP) prevails, but in the other group (the control), the FTEP is missing. Since the research design is quasi-experimental, there is no randomization of subjects into the two groups (Dutra & Reis, 2016).

However, similarities between the two groups in terms of age, gender, and medical background for coronary artery disease, chronic obstructive pulmonary disease, and diabetes, are indicated. Participants in group A underwent esophagectomy before the introduction of the FTEP, while the second group (group B) underwent surgery after the institution of the FTEP.

Even though there are similarities in the baseline characteristics mentioned above, the number of participants in both groups is different. The researchers include 322 participants in group A and 386 participants in group B. Also, there is variation in tumor histology, pathological stage, tumor location, tumor grade, and distribution in clinical staging of the tumor (Shewale et al., 2015, 1117-1118).

The article does not indicate the concealment of the intervention because the research method is retrospective in nature and relied on secondary data. In addition, in comparison to true experimental studies: the randomized controlled trials (RCTs), there is no blinding in quasi-experimental studies (Misra, 2012). The research eliminates bias associated with recall and the researcher because the Esophageal Department Database is the source of research data.

Thereby, there is no manipulation of results in favor of the research. The kind of medical care given to the two groups is lacking; thus, there is difficulty in determining equality in the treatment given to the two populations. Since the researchers rely on a database, the kind of treatment received by the patients after esophagectomy is not known. Yet, the skills and professionalism of the medical team tend to influence health outcomes. Under such circumstances, the treatment effect is affected as well as the preciseness of the results.

Shewale et al. (2015) do not indicate the reason for choosing a quasi-experimental study over an RCT is not clear because there is no indication of negative ethical implications associated with the RCT. In reference to CASP (2013), the reader prefers the use of an RCT. An RCT is more beneficial and yields more valid and reliable results if used in a similar study but a different location. The nature of the studys research design is cost-effective, but the study is worth the effort.

The study informs future RCTs and advocates for a look at other parameters, such as patient approval and satisfaction. Various measures are of interest, including the length of stay, duration of days of using a mechanical ventilator immediately after surgery, ventilator days before discharge, all days spent in the ICU (SICU), days spent in the telemetry unit, postoperative complications to indicate overall outcomes of the surgery. The MDACCs enterprise information warehouse provided information on hospital charges.

Results

The results include all the participants targeted at the start of the study; there is no attrition or non-response because the study extracts data from a database. The article talks of significant differences in the length of stays, some postoperative complications including acute respiratory distress syndrome, and days spent in the ICU and telemetry units between the two groups. But, the treatment effect of the FTEP compared to no FTEP is not shown.

In reference to McGough and Faraone (2009), the application of effect size is dependent on the type of research methodology, and Shewale et al. (2015) does not guarantee the rigor of the research method used. After regression analysis, the indication of the confidence interval for the length of stays, pulmonary complications, and hospital charges helps to determine the precision of the study results. Confidence limits help to indicate the preciseness of results; a higher limit is associated with a low level of preciseness while the converse is true.

The results show significantly longer length of stays, significantly higher number of days spent in the ICU and telemetry units, a higher number of days with the ventilator in group A as opposed to group B. Postoperative complications, such as admission in the ICU, is significantly higher in group A than B. Other postoperative complications like pneumonia, aspiration, anastomotic leak, reoperation, readmission in the ICU, discharging patients while on patient oxygen, and atelectasis is not significantly different between the two groups.

Also, there is no significant difference in 30-day mortality and 90-day readmission between the two groups. The confidence interval for the effect of the FTEP in reducing the length of stays indicates a low level of preciseness, as shown by an association coefficient of -6.415 at a confidence interval of 8.294 to -4.536. However, the association between the FTEP and pulmonary complications is more precise, as shown by a correlation coefficient of 0.655 at a confidence interval of 0.456 to 0.942.

Overall, hospital charges for group A, compared to group B, are significantly higher, and a multivariate analysis shows a negative association. There is selective reporting because among the postoperative complications of interest, discharging a patient with a jejunostomy tube is among the outcomes of interest. Unfortunately, the article does not give details about the provision of a jejunostomy tube and ones ability to feed after surgery. Thereby, in such studies, discussing the feeding abilities of the patient is paramount. A patients feeding abilities is one of the major reasons for readmission.

Conclusion

Critical appraisal of results is important in decision-making and future research. Future researchers are able to gain insight into ideal strategies for minimizing bias likely to affect the validity and reliability of results. Based on the appraisal of Shewales et al. (2015) study, quasi-experimental studies lack the rigor and credibility present in randomized controlled trials. As a researcher, giving the use of RCTs priority is imperative.

References

Critical Appraisal Skills Programme (CASP). (2013). CASP checklists. Web.

Dutra, H. S., & Reis, V. N dos. (2016). Experimental and quasi-experimental study designs: definitions and challenges in nursing research. Journal of Nursing, 10(6), 2230-2241.

McGough, J. J., & Faraone, S. V. (2009). Estimating the Size of Treatment Effects: Moving Beyond P Values. Psychiatry (Edgmont), 6(10), 2129.

Misra, S. (2012). Randomized double-blind placebo control studies, the Gold Standard in intervention-based studies. Indian Journal of Sexually Transmitted Diseases, 33(2), 131134.

Reviriego, E., Cidoncha, M. A., Asua, J., Gagnon, M., Mateos, M., Garate, L., & Gonzalez, R. M. (2014). Online training course on a critical appraisal for nurses: adaptation and assessment. BMC Medical Education, 14(136). Web.

Shewale, J. B., Correa, A. M., Baker, C. M., Villafane-Ferriol, N., Hofstetter, W. L., Jordan, V. S., & The University of Texas MD Anderson Esophageal Cancer Collaborative Group. (2015). Impact of a Fast-Track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges. Annals of Surgery, 261(6), 11141123.

What are the study problem and purpose?

The study problem is that HF is contributing to psychological distress and decreased quality of life (QOL). There is no previous information on the efficacy of nursing interventions or strategies that would enhance the well-being and QOL among HF population. The purpose of this study is to examine the effectiveness of two nursing interventions in improving QOL and mental health among individuals with HF receiving home care. These are described in the page no.248.

Is the problem sufficiently narrow in scope without being trivial? Does the purpose narrow and clarify the focus or aim of the study and identify the research variables, population, and setting.

The problem is not sufficiently narrow in scope. This could be because the occurrence of HF has become an ever-increasing epidemic threat. It may contribute to adverse health problems which could place a serious economic burden for the health care agencies. The purpose is not narrow and did not focus the study. This could be because there were no clear description that why nursing interventions are important to address the problem.

In addition, there was no information on study inconsistencies or pitfalls associated with the nursing interventions. The research variables are patients with HF, Psychological disturbances, mutual goal setting and supportive educative intervention, Mental health and quality of life (QOL). The population is HF individuals from nonprofit home health care agencies and the setting is an Outdoor experimental one.

Is the problem significant and relevant to nursing?

The problem is significant and relevant to nursing. This could be because strategies like interventions described are mainly intended to study and address the problem with the objective of inducing a change like in the QOL. So, in the present study, there seem to be three kinds of interventions which are in agreement with the nursing.

Was the study feasible to conduct in terms of money commitment; the researchers expertise; availability of subjects, facility, and equipment; and ethical considerations?

The study is feasible, but with some limitations to conduct the research. In terms of money commitment, the study may require some additional funds. Large screening programs at various geographical settings need to be instituted which may demand an additional expenditure.

The availability of subjects is poor and may be increased to approximately 250. The facilities although appear to be satisfactory need much clarification and the number of equipments in the form of scales are low and the incorporation of additional measuring scales may be demanded.

Ethical consideration is however addressed due to the fact the investigators have followed a method of obtaining informed consent or scripted form the study participants. This was done to preserve the ethics of patient values in terms of privacy, respect and freedom.

Literature Review

Are relevant previous studies identified and described?

The relevant previous studies have been identified but not thoroughly described. There seems to be few relevant studies by Grady et al 1998; Bennet et al.2000 and others mentioned in the page no.249. However, there was no proper link with these studies. There should be much more information on why the relevant previous studies have been described.

Are relevant theories and models identified and described?

Relevant theories and models have been identified; but models have not been described. Theories like Orems Theory of Self Care and Kings Theory of Goal Attainment although were pointed out while making study comparisons in the page no.251. Similarly, in the page no 250, fig 1 resembling a model was represented. However, the description is poor.

Are the references current? Examine the number of sources in the past 5 and 10 years in the reference list.

The cited references are not current. The number of sources in the past 5 years are none and that in the past 10 years are only 5. This is evident from the page no.256

Are the studies critiqued by the author?

The studies were not critiqued by the author. The studies were simply highlighted with an attempt to bring about their own significance. For example, in page nos 249 and 255 the references cited are supported for the study.

Is a summary of the current knowledge provided? This summary needs to include what is known and not known about the research problem.

Summary of the current knowledge is not adequately provided. HF is contributing to ever increasing physical, psychological disturbances and altered quality of life (Scott, Setter-Kline & Britton, 2004, p.248). Educational interventions have been devised and targeted

to enhance knowledge of treatment, HF symptoms, and uncertainty about disease progression. Nursing strategies that could improve perceptions of well-being and QOL among the population are largely demanded (Polit & Beck, 2007). Similarly, QOL may have certain important components which seem to be unknown or uncovered in the research problem (Polit & Beck, 2007). These are more probably related to mental or psychological conditions like sense of control or perceived loss of control, uncertainty, feelings of powerlessness anxiety and mood disturbances (Scott, Setter-Kline & Britton, 2004, p.255) The description about the pharmacological intervention was poor.

Is the literature review organized to demonstrate the progressive development of ideas through previous research?

The literature review is organized to demonstrate the progressive development of ideas through previous research. In page 249, it has taken help of earlier findings and described a consistency. However, certain psychological problems relevant to HF described in the literature did not reflect the hidden or underlying problem where HF has turned out to be an ever-increasing health concern with epidemiological warnings.

Is a theoretical knowledge base developed for the problem and purpose?

A theoretical knowledge base was developed for the problem and purpose. This could have been done from Kings Theory of Goal Attainment (1981) and Orems Theory of Self-Care (2001) from the page no.251.

Does the literature review provide a rationale direction for the study?

The literature review has provided a rationale direction for the study. In the page no 249, by taking the help of previous findings, it identified the key points relevant to the problem, purpose, and objectives. However, there were certain inconsistencies in the literature which has made the rationale direction feeble. This has to be provided in the introduction part of page no.248 which is missing.

Does the summary of the current empirical and theoretical knowledge provide a basis for the study?

The summary has provided a basis for the study keeping in view of proposed nursing strategies or interventions.

Study Framework

Is a study framework identified? Is the framework explicitly presented or must it be extracted from the literature review? Is the framework presented with clarity?

A study frame work was identified. But it is not straightforward. This seems the one represented in the Fig no.1 of page no 250. It was not explicitly presented and is need of further variables to be incorporated to reflect the expected outcome. Thus, the study framework is not as clear at an anticipated level.

Is a particular theory or model identified as a framework for the study?

A particular theory or model was identified for the whole study. Kings Theory of Goal Attainment and Orems Theory of Self-Care as descrined in the page no.251 made a basis the study framework.

Does the framework describe and define the concepts of interest? Does the framework present the relationships among the concepts? Is a map or model of the framework provided for clarity?

The framework has poorly described and defined the concepts of interest. The framework has adequately presented the relationships among the concepts (Polit & Beck, 2004, p.114, 125). A map or model of the framework was not provided for clarity. Instead a schematic representation of study variables was provided.

Link the concepts in the framework with the variables in the study. Is the framework linked to research purpose? Would another framework fit more logically with the study?

The concepts in the framework like QOL, health-related QOL, health status, and

functional status is well influenced by domains like health/functioning, family, socioeconomic, and psychological/spiritual (Scott, Setter-Kline & Britton, 2004, p.252). These were evaluated with Mental Health Inventory-5 (MHI-5), a subscale of the Medical Outcomes Study Health Status Questionnaire Short Form 36, and Quality of Life Index (QLI) (Scott, Setter-Kline & Britton, 2004, p.251).

For this purpose, variables like Patients with HF, psychological disturbances, mutual goal setting intervention, supportive educative intervention, mental health quality of life were considered (Scott, Setter-Kline & Britton, 2004, p.250). However, the framework is poorly connected to the research purpose. There is a need of another framework that could fit more logically with the study (Polit & Beck, 2004, p, 134).

Is the framework related to nursings body of knowledge?

The framework is significantly related to nursings body of knowledge. This is because a nursing strategy in the form of intervention is being vividly reflected.

If a proposition from a theory is to be tested, is the proposition clearly identified and linked to the studys hypothesis?

A proposition from a theory needs to be tested since there is no clear identification of proposition and its connection to the studys hypothesis. Moreover, as the study also seems deficient in highlighting a particular theory, a relationship with a theory could not be established.

Research Objectives, Questions, or Hypotheses

Are the objectives, questions, or hypotheses clearly and concisely expressed?

The objectives, questions, or hypotheses are clearly and concisely expressed as described in page nos.249 and 250.

Are the objectives, questions, or hypotheses logically linked to the research purpose?

The objectives, questions, or hypotheses are linked to the research purpose.

Are the research objectives, questions, or hypotheses linked to concepts and relationships (propositions) from the framework?

The research objectives, questions, or hypotheses are linked to concepts but not to the any relationships or propositions from the framework. The objective of examining the effectiveness of two nursing interventions as described in the page no.248 is linked to concept of interventions or strategies required for any study, in the nursing context. Similarly, relationships like physiological disturbances, QOL and other adverse effects of HF as described in the page no 249 are also linked to the objective.

Variables

Are the major variables or concepts identified and defined (conceptually and operationally)? Identify and define the appropriate variables included in the study

The major variables or concepts are clearly identified and defined. The appropriate variables in the study are patients with HF, psychological disturbances, mutual goal setting intervention,

supportive educative intervention, mental health quality of lifeage and gender (Scott, Setter-Kline & Britton, 2004). The identification of variables is essential for the implementation of nursing interventions (Polit & Beck, 2007).

Independent

Supportive Educative or Mutual goal setting intervention

Dependent

Mental Health, QOL.

Research variables or concepts

Mental Health, QOL, patients with HF, psychological disturbances, mutual goal setting intervention, and supportive educative intervention,

Do the variables reflect the concepts identified in the framework?

The variables have reflected the concepts identified in the framework. The variables like Mental Health, QOL, patients with HF, psychological disturbances mentioned in the page no 250 have represented the concepts on intervention.

Are the major variables or concepts identified and defined (conceptually and operationally) based on previous research and/or theories?

Based on previous research and/or theories, major variables mentioned in the page no 250 were identified and clearly defined.

Is the conceptual definition of a variable consistent with the operational definition?

The conceptual definition of a variable is consistent with the operational definition. The variable, supportive educative intervention as described in page 250 although were defined keeping in view practical accomplishment during the study.

What attribute or demographic variables are examined in the study?

Socioeconomic conditions, health/functioning, family, and psychological/spiritual domains resulting from the two nonprofit home health care agencies in the Midwest region could be considered as demographic variables are examined in the study (Scott, Setter-Kline & Britton, 2004, p.250).

Design

Is the research design clearly addressed? Identify the specific design of the study. Was the best design selected to direct this study?

The research design was clearly addressed. The specific design of the study was that patients with HF who are having Psychological disturbances should receive interventions like Mutual goal setting and supportive education. This could ensure the achievement of improved mental health and quality of life (QOL). This is the good design selected to direct this study.

Does the design provide a means to examine all of the objectives, questions, or hypotheses and the study purpose?

The design has provided a means to examine all of the objectives like to examine the effectiveness of two nursing interventions questions, or hypotheses that the nursing intervention could improve the mental health and QOL and the study purpose like n enhancement of mental health and QOL among individuals as described in page no 248.

Does the study include a treatment or intervention? If so, is the treatment clearly described and consistently implemented? Is the treatment conceptually and operationally defined? Is the treatment appropriate for examining the study purpose and hypotheses?

The study does not include a treatment but has emphasized on nursing intervention. The study has provided adherence to implications for treatment options supported by the previous literature. Therefore, there is no clear description on treatment in terms of concept and/ or specificity for the research purpose and hypotheses.

Are the extraneous variables identified and controlled?

The extraneous variables were clearly identified and but not controlled. This is because the extraneous variable attrition which occurs when a subject quits the experiment while the experiment is in progress was not controlled. Here, decline of participants from the study was described in page no.252.

Were pilot study findings used to design the major study? If so, briefly discuss the pilot study and the findings. Indicate the changes made in the major study based on the pilot.

The pilot study findings were not used in the major study.

What are the threats to design validity? Were these threats identified by the researcher?

The threats to design validity are the limited number of participants, sample convenience and sole dependence on the routine nursing care.

Have the threats to design validity (statistical conclusion validity, internal validity, construct validity, and external validity) been minimized?

The threats have not been minimized. This could be attributed to deficiency in appropriate sample size, sample screening using additional instruments or measurement etc.

Is the design logically linked to the sampling method and statistical analyses?

The design is logically linked to the sampling method and statistical analyses.

The employment of 88 HF individuals has facilitated to conduct a power analyses to determine the sampling method before the initiation of the study.

Sample, Population, and Setting

• Is the target population to which the findings will be generalized defined? Are the inclusion and exclusion sample criteria described? Did the researchers indicate the method used to obtain the sample? Is the sampling method adequate to produce a sample that is representative of the study population? What are the potential biases in the sampling method?
  • The target population to which the findings will be generalized were defined. The inclusion and exclusion sample criteria were not clearly described. However, participant eligibility for enrollment was described like they should have a primary diagnosis of HF, (2) be 18 years or older, and (3) understand and speak English (Scott, Setter-Kline & Britton, 2004, p.250). The deviations from this eligibility conditions could be considered for exclusion criteria. The sampling method is not adequate to produce a sample that is representative of the study population. The potential biases in the sampling method are increased proportion of female gender.
• Identify the sample size and indicate if a power analysis was conducted to determine sample size. What number and percentage of the potential subjects refused to participate? Is the sample size sufficient to avoid a Type II error?
  • The sample size is 88. A power analysis was conducted to determine the sample size needed for each group (Polit & Beck, 2004, p.495). For studies using three repeated measures (entry into the study, 3 and 6 months), with an alpha _.05, a power of.80, and a moderate effect size, 30 participants were needed for each intervention group. 7 (7.95%) of the potential subjects refused to participate (Scott, Setter-Kline & Britton, 2004, p.252). The sample size is not sufficient to avoid a Type II error.
• Identify the characteristics of the sample. Identify the sample mortality or attrition from the study. If more than one group is used, do the groups appear equivalent?
  • As described in the table 2 of page no 25, the characteristics of the sample are Age, Gender, Marital status, 8th12th grade Education, Income, and Time since HF diagnosis. By the end of the 6-month data collection period, 22 participants were no longer in the study. Seven participants declined participation at 3 months, whereas seven expired or were too ill to continue in the study. The remaining six participants were either lost to follow-up (n _ 5) or had transitioned to a nursing home (n _ 1). The groups did not appear equivalent (Scott, Setter-Kline & Britton, 2004, p.252).
• Discuss the institutional review board approval and informed consent obtained. Are the rights of human subjects protected? Are the HIPAA privacy regulations followed in the study?
  • Approval for the research procedure was obtained from all appropriate human subjects committees and informed consent was obtained from the participants (Polit & Beck, 2004, p.150). The rights of human subjects appear to be protected. Although there is no clear information, it is reasonable to mention that HIPAA privacy regulations followed in the study were being followed in the study.
• Discuss the setting and whether it was appropriate for the conduct of the study. Is the setting used in the study typical of clinical settings?
  • An experimental, repeated-measure setting was used in his studies and it was appropriate for the conduct of the study. The setting used is not the study typical of clinical settings.

Measurements

Are the measurement strategies described by author, type, level of measurement, development, reliability, and validity?

No. the measurement strategies described by author, type, level of measurement, development, reliability, and validity.

Do the instruments adequately measure the study variables?

The instruments did not adequately measure the study variables.

Are the instruments sufficiently among subjects?

The instruments are not sufficient among subjects. There could have been additionally at least another two instruments to meet the study requirements

Is the reliability of the instruments adequate for use in the study?

The reliability of the instruments seems inadequate for use in the study

Is the validity of the instruments adequate for use in the study?

The validity of the instruments is inadequate for use in the study. This is because, the selected instruments in the page no 251 seem not so reliable for a concrete utilization.

Do the instruments need further research to evaluate validity and reliability.

The instruments need further research to evaluate validity and reliability.The provided instruments have not ensured complete reliability of the parameters under study

Scales and Questionnaires

• Are the instruments clearly described?
  • The instruments clearly described in page nos 251 and 252.
• Are the techniques to administer, complete, and score the instruments provided?
  • The techniques to administer, complete, and score the instruments were not provided.
• Are the reliability and validity of the instruments described? Did the researcher examine the reliability and validity of the instruments for the present sample?
  • The reliability and validity of the instruments was not clearly described. The researcher did not examine the reliability and validity of the instruments for the present sample.
• If the instrument was developed for the study, is the instrument development process described?
  • The instrument was not especially developed for the study.

Observation

• Is what to be observed clearly identified and defined?
  • Improvement in the QOL and mental health conditions and overall lessening of HF.
• Are interrater and intrarater reliability described?
  • There were no interrater and intrarater reliabilities described. In page nos 251 and 252, a brief description was given on the instruments.
• Are the techniques for recording observations described?
  • The techniques for recording observations were not described.

Interviews?

• Do the interview questions address concerns expressed in the research problem?
  • The interview questions have addressed concerns expressed in the research problem.
• Are the interview questions relevant for the research purpose and objectives, questions, or hypotheses?
  • The interview questions are relevant for the research purpose and objectives, questions, or hypotheses.
• Does the design of the questions tend to bias subjects responses?
  • The design of the questions did not tend to bias subjects responses. It seems that the questions could have been set keeping in view of the three study interventions as seen in page no s 251-253.
• Does the sequence of questions tend to bias subjects responses?
  • The sequence of questions did not tend to bias subjects responses. Actually, there is insufficient information on the sequence of questions in the procedure section of page no 250-252

Physiologic Measures

• Are the physiological measures or instruments clearly described?
  • The physiological measures or instruments were clearly described. However, a much more description could have made it clearer.
• Are the accuracy, precision, selectivity, and error of the physiological instruments discussed?
  • The accuracy, precision, selectivity, and error of the physiological instruments were not clearly discussed.
• Are the methods for recording data from the physiological measures clearly described?
  • The methods for recording data from the physiological measures were not clearly described.

A brief definition was given and not explained much which could be seen in page no 251.

Data Collection

How were the study procedures implemented and data collected during the study? Is the data collection process clearly described? Is the training of data collectors clearly described and adequate?

In the page no.250 and 251, a scripted approach was implemented and through informed consent initial baseline data were collected and participants were randomly assigned to one of three nursing intervention groups (mutual goal setting, supportive-educative, or placebo) by the principal investigator using a table of random numbers(Scott, Setter-Kline & Britton, 2004,p.250). The data collection process is not clearly described. The training of data collectors was not clearly described and seems inadequate.

Is the data collection process conducted in a consistent manner?

The data collection process seems to be conducted in an inconsistent manner. This is because in the page no.250 and 251, there is no sufficient information on the time interval followed while collecting the data.

Are the data collection methods ethical?

The data collection methods seemed to be ethical. This is because a written consent method was followed while obtaining the information from the participants, as seen in page no.250.

This is nothing but protecting and respecting the rights and freedom/privacy of the participants which is in agreement with the ethical laws.

Do the data collection methods address the research objectives, questions, or hypotheses

The data collection methods addressed the research objectives, questions, or hypotheses. As seen in procedure section of page no.250 and 251, data was collected keeping in view of three nursing interventions groups. However, about the HF severity and QOL, there should have been some additional strategies like follow up.

References:

Polit, F., Beck. (2004). Nursing Research: Principles and Methods 7th edition. Lippincott.Philadelphia. Web.

Scott, L.D., Setter-Kline, K., & Britton A. S. (2004). The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Applied Nursing Research, 17, 248-256.

According to the definition provided by Doyle & Keogh (2008), neuroleptic malignant syndrome (NMS) is a rare, but a potentially threatening to life reaction, which occurs as a result of prescribing a neuroleptic medication. In the majority of instances, such an idiosyncratic reaction occurs after the administration of a medication such as Haloperidol, which is a typical antipsychotic. NMS occurs in only 0.2% to 1% of patients, which were prescribed to take either first or second-generation antipsychotics. In 10% of cases, the syndrome can be fatal; furthermore, in some cases, it has been diagnosed in patients after twenty years of medical treatment (Halter, 2014).

Symptoms of neuroleptic malignant syndrome include reduced state of consciousness, increased the rigidity of muscles, as well as autonomic dysfunction (drooling, tachypnea, labile hypertension, tremor, elevated white blood cell count, urinary inconsistency, elevated pulse, and other symptoms). Treatment of neuroleptic malignant syndrome is multi-dimensional; not only does it include pharmacological interventions, but symptomatic management can also be resolved using symptomatic management, for example, pyrexia is also reduced with a cooling blanket or a fan (Doyle & Keogh, 2008).

On the other hand, early diagnosis is one of the most effective methods for dealing with NMS, although it can be limited by the lack of evident muscle rigidity. Therefore, nurses should be aware of the key symptoms and diagnose them as soon as possible.

Pharmacological interventions used for treating neuroleptic malignant syndrome are associated with the administration of Bromocriptine (in mild cases) and Dantrolene (intravenous, in severe cases) (Halter, 2014). In cases when the patient has the fever, paracetamol is prescribed. As mentioned by Doyle & Keogh (2008), ECT has also proven to evoke a rapid response and improve the underlying psychiatric condition. Because neuroleptic malignant syndrome is idiosyncratic in nature, it is complicated for nurses to accurately predict its development and implement a timely prevention intervention.

Nursing care in cases of neuroleptic malignant syndrome consists not only of body temperature management. Nurses also conduct routine observations that are carefully documented; if any abnormalities are observed, a nurse reports them to a responsible practitioner (Doyle & Keogh, 2008).

Apart from observations and temperature management, nurses assist NMS patients with their everyday activities and help them regain confidence in reality orientation in cases of confusion and overall altered mental status. Dehydration is also managed by the administration of intravenous fluids while nutritional support is conducted through assistance in eating and drinking if the patient experiences an altered mental status.

In typical cases of NMS, the syndrome usually lasts from five to seven days after the administration of the drug has been discontinued. If depot antipsychotics have been used, the syndrome may last longer than seven days. Therefore, patients with a recorded history of neuroleptic malignant syndrome are not recommended to go through an antipsychotic therapy and should rather be prescribed alternative methods of treatment such as the administration of benzodiazepines, carbamazepine, and lithium (Doyle & Keogh, 2008).

As nurses, we are responsible for monitoring patients for any signs of the neuroleptic malignant syndrome to prevent the condition from developing and negatively impacting patients health. It is crucial to mention that the syndrome calls for a multi-dimensional approach, which includes both pharmacological and symptom management interventions. To conclude, the symptoms of the syndrome should be carefully monitored and, if necessary, addressed.

References

Halter, M. (2014). Varcarolis Foundations of psychiatric mental health nursing: A clinical approach (7th ed.). St. Louis, MO: Elsevier Inc.

Keogh, B., & Doyle, L. (2008). Psychopharmacological adverse effects. Mental Health Practice, 11(6), 28-30.

Nowadays the problem of paraplegic patients transitioning has become of great importance. Regardless of their physical abilities, all people have the same rights. The list of activities in which paraplegic patients take part is enlarging now. Consequently, the demand for new mechanical devices is expected to be increasing. The most challenging issue is the inability to stand and walk (Farris et al. 482).

Therefore, technologies are concentrated on sitting, standing, and walking movements that are fundamental for any type of activity (Quintero, Farris, and Goldfarb 16). However, it is necessary to improve them and enable customers to perform more complex activities, for instance, to use a Jacuzzi.

In this context, one of the most significant requirements imposed on such devices is the opportunity to use them independently because family and care-givers do not always have the chance to assist. Apart from that, security and reliability are equally urgent because a person should be protected from any trauma and the absence of timely treatment (Drugs.com par. 11). Thus, the importance of work in this sphere is beyond doubt. As a result, transfer devices companies attention should be drawn to the capability to perform routine actions individually.

Under these circumstances, the project introduces the portable board with special stoppers. The purpose of the device is to help paraplegic patients move from their wheelchair to the Jacuzzi and vice versa without any assistance from other people. First and foremost, the construction will be easy to use. The opportunity to use it will presumably boost their confidence in their strength and help practically.

The most important benefit is that the construction will provide safety: owing to the fact that rubber stoppers will protect the device from sliding, the risks of injury are lower. It will also be possible to screw the board to the wall. A person who should use their hands to move will be aware that they will not slide. Another advantage of the promoted device will be connected with its transportability: the board will be light, quite compact, and easy to carry.

The background research proves the potential effectiveness of the promoted device. Sometimes, it is difficult for patients to understand how to use a certain construction in the process of transferring. Because of these problems, mishaps are one of the major causes of injuries (Akyol et al. 1). In comparison, the portable board for the Jacuzzi will bring positive results since patients educated by health care professionals once will soon develop the necessary skills.

It is expected that the training will take several days on condition that a person has some experience of using similar devices for different purposes (for example, moving from ones wheelchair to bed). Good upper body and arm strength will significantly increase the speed of learning (McNitt-Gray et al. 133). In terms of housing, the need for greater adaptability, flexibility, and accessibility becomes one of the most crucial issues because it is the essential environment for a person in which they spend most of their time (West 21). The proposed project directly addresses the house setting and gives a solution.

Paraplegic patients with satisfactory upper body and arm strength are the desired client base. Besides, health specialists who will be installing, training, and operating the device also constitute the target audience for the report. Since these categories deal with paraplegic issues on a daily basis, they are potentially interested in the device that should help patients perform various actions.

Works Cited

Akyol, Erman, et al. A Study on Understanding of Wheelchair Transferring Action. Bulletin of Japanese Society for the Science of Design 61.1 (2014): 1-6. Print.

Drugs.com. Wheel Chair Transfers. n.d. Web.

Farris, Ryan J., et al. A Preliminary Assessment of Legged Mobility Provided by a Lower Limb Exoskeleton for Persons with Paraplegia. IEEE Transactions on Neural Systems and Rehabilitation Engineering 22.3 (2014): 482-490. Print.

McNitt-Gray, J., et al. Factors Contributing to The Mechanical Demand Imposed on the Upper Extremity During Manual Wheelchair Propulsion. The Journal of Science and Medicine in Sport 18.1 (2014): 130-138. Print.

Quintero, Hugo A., Ryan J. Farris, and Michael Goldfarb. A Method for the Autonomous Control of Lower Limb Exoskeletons for Persons with Paraplegia. The Journal of Medical Devices 6.4 (2012): 16-21. Print.

West, Simone. Accessible Housing and the New National Technical Standards. The Journal of Building Survey, Appraisal & Valuation 5.1 (2016): 21-29. Print.

Research Evidence of the Effectiveness of Telehealth

The practices of telehealth refer to the provision of healthcare services on a distance (Schlachta-Fairchild, Elfrink, & Deickman, 2008). This term can be used along with or replaced by such terms as telenursing and telemedicine. In that way, searching for the relevant research and evidence concerning the practice of telehealth must include all of these variations of the name. The body of research exploring the effectiveness of telehealth practices is substantial and concerns many different fields such as mental health, pediatrics, maternal care, chronic diseases, and long-term care, among others (CADTH, 2016).

The American Telemedicine Association (ATA) specializes in the collection of data and research as to the effectiveness of practices in this sphere. Currently, the ATA has a sufficient body of information that confirms the cost-effectiveness of telehealth for both the care providers and the patients (American Telemedicine Association, 2015). Namely, the researchers find that the telehealth models can adequately support the primary care practices and reduce the pharmacy and medical costs of the treatments, reduce the number of admissions to the hospital; in addition, telemedicine was reported to improve the patient experiences and overall treatment outcomes (American Telemedicine Association, 2015).

In particular, the study by Salisbury et al. (2016) demonstrated the effectiveness of telemedicine in depression and anxiety treatments and showed a higher response rate to this type of treatment. However, the research by Dixon (2016) that also involved the depression patients showed that the cost-effectiveness of the telemedicine approach was low due to the consumption of the practitioners time and the comparatively low gain in QALY. The evidence collected by NHS (n. d.) presented the results of home telemonitoring of the patients with diabetes, COPD, and heart failure and showed that in all three conditions, telemedicine helped reduce mortality and hospitalization rates significantly.

As a result, a conclusion may be made that telemedicine is a somewhat practical approach when applied to mental health conditions, chronic diseases, and long-term health problems. The primary positive effects for public health were the reduction of the mortality rates and hospitalization cases, thus reducing the hospitals costs. However, the time and effort spent on the provision of distance care are some significant factors that reduce the cost-effectiveness of the telehealth models.

Challenges Faced

Even though telemedicine is widely recognized as an effective, innovative approach that can strengthen primary and preventive care, it has a number of disadvantages. Practicing telemedicine, medical professionals are likely to face versatile challenges. For example, my experience of the telemedicine model was complicated by the fact that it targeted mainly the elderly population and required the use of the Internet (emails) and telephone connection. The problem was that almost none of the patients had regular access to the Internet or knew how to use the computers. Telephone communication was complicated by the fact that many patients had hearing and memory issues, and the likelihood was high that the patients would either misunderstand, misinterpret, or forget the information provided over the phone.

My personal impression was that telemedicine approaches that target the patients of age are far more effective when they include the caregivers (family members of close people), and the instructions are provided to the latter as well as the patients in order to ensure appropriate supervision. The report by OConnell (2015) supported this point of view and provided evidence that the supervision was critical in the telehealth models based on self-assessment, daily questionnaires, and home testing.

In addition, there are many ethical questions that apply to the use of telemedicine when the monitoring and supervision are provided by the people who are not licensed medical professionals; some of these issues involve the acquisition of confined agreement to undergo procedures, and the appropriateness of the inclusion of untrained people in such activities as collecting and handling the medical test results (OConnell, 2015). In other words, telemedicine may save costs to healthcare institutions, but it is also likely to cause a decrease in morality.

Another personal observation to add to this report concerns the importance of the stable connection between the medical personnel and the patients. Its meaning has been established and confirmed as a factor that improves patient experience, treatment response, and trust between the patient and the medical professionals. Telemedicine attempts to limit the in-person contact of the two parties and is likely to lead to the loss of trust and alienation of the patients (Hjelm, 2005).

Telehealth as an Alternative to Face-to-Face Practice

By nature, medicine, first and foremost, relies on the results of testing and assessments. As specified by Singh (2016), in some areas of health care, the results collected by telehealth methods can be equal in terms of their precision to the ones collected during a face-to-face assessment. However, many of the assessments cannot be conducted by the patients autonomously or by their caregivers.

In particular, such tests involve the use of complex equipment that requires that a professional or a specifically treated person operates it. In this aspect, face-to-face care is more beneficial. Besides, even though such methods of data collection as questionnaires that can be equally misleading when a patient does not disclose full information, during an in-person assessment, the medical professional can rely on their individual perception of the patients behavior and body language and detect whether or not the truth is being told. In this aspect, the advantage is also on the side of face-to-face medicine.

However, the studies show that telemedicine can be effective in the form of primary care, prevention strategies, and follow-up treatments (Gulla, 2013). This form of care allows the medical professionals to monitor a larger number of patients and provide a deeper and more thorough level of care the stretches out beyond the clinical settings.

To conclude, the results of efficiency and cost-effectiveness of telehealth differ depending on the area where it is applied and the type of care that is provided on distance. Basically, the results are controversial because, in different fields, the practices show different results. More research is required in order to find out which areas are more and less compatible with this form of care.

References

American Telemedicine Association. (2015). Research Outcomes Telemedicines Impact on Healthcare Cost and Quality. Web.

CADTH. (2016). Telehealth: Summary of Evidence. Web.

Dixon, P., Hollinghurst, S., Edwards, L., Thomas, C., Foster, A., Davies, B.,& Montgomery, A. A. (2016). Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial. British Journal of Psychiatry Open, 2(4), 262-269.

Gulla, V. (2013). Telehealth Networks for Hospital Services: New Methodologies. Hershey, PA: IGI Global.

Hjelm, N. M. (2005). Benefits and drawbacks of telemedicine. Journal of Telemedicine and Telecare, 11(2), 60-70.

NHS. (n. d.). Telehealth for patients with long term conditions. Web.

OConnell, P. (2015). Advantages and Challenges to using Telehealth Medicine. Global Journal of Medical Research, 15(4), 19-22.

Salisbury, C., OCathain, A., Edwards, L., Thomas, C., Gaunt, D., Hollinghurst, S.,& Montgomery, A. A. (2016). Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomised controlled trial of a complex intervention. The Lancet Psychiatry, 3(6), 515-525.

Schlachta-Fairchild L., Elfrink V., & Deickman A. (2008). Patient Safety, Telenursing, and Telehealth. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (pp. 135-145). Rockville, MD: Agency for Healthcare Research and Quality.

Singh, N. N. (2016). Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities. New York, NY: Springer.

Retrograde pyelography is an invasive inspection of the kidneys from a distal way through the ureters (Chernecky and Berger 983). It has been used as a primary method infrequently, but it has a few probable signals when it can be a secondary method. Retrograde pyelography is mostly used to examine lacerations of the ureter. It generally necessitates a universal painkilling, and may end in the introduction of germs (Kumar and Clark 571).

The test can help discover what is the basis of the patients urinary issue. It can recognize obstacles such as tumors or tapering in the kidneys. It is habitually done if other examinations have been unconvincing. The test should expectantly give a better definition of the patients health problem so that the doctor could suggest appropriate treatment. The retrograde pyelography is normally done as a daytime procedure, with no overnight stay.

Antegrade pyelography is an invasive radiographic procedure in which radiocontrast substance is inserted percutaneously into the renal pelvis. The patient needed an antegrade pyelogram because other imaging examinations did not give the doctor enough evidence to reach a verdict (Chernecky and Berger 984).

The patient may have a blockage and the dye would not flow any further or may be deferred in the kidney. The antegrade pyelogram may also be used to evaluate the state of the patients kidneys. It can either prevent the surgical intervention or represent a follow-up procedure. In this case, the doctor may use a special pipe to pass the urinal flow around the obstruction or use a kidney pipe to release the blockage.

In this patients case, the retrograde and antegrade pyelography were required to detect and further examine hematuria. These two approaches are relatively helpful and were designed to assist in the projection and assessment of the urinary tract issues. The case showed that the procedures were carried out properly. Therefore, retrograde and antegrade pyelography helped to diagnose bladder tumor and the transitional cell carcinoma of the bladder (Kumar and Clark 572).

The medical worker should clarify the benefits and dangers of having retrograde pyelography, and correspondingly discuss the substitutes to the method. After that, the doctor will scrutinize the X-ray images to notice if there is any disruption in the flow. It is important to talk about the results of the patients test with him. The incidence of difficulties is subject to the exact type of procedure and patients general health. The doctor should also discuss the probable risks with the patient.

Cystoscopy is a type of examination that permits the doctor to look at the inner sides of the bladder using a thin tool termed a cystoscope (Gingell and Abrams 66). The cystoscope has been put into the patients urethra and gradually introduced into the bladder. Cystoscopy lets the doctor see the parts of the patients bladder and urethra that typically are not perceived well on X-rays. Miniature surgical utensils can be introduced via the cystoscope that let the doctor complete the tissue removal or get rid of the urine samples. Tiny tumors and bladder stones can be eliminated throughout the cystoscopy.

This may eradicate the necessity for more surgery, but it might be the reason of blood leavings in the patients urine. A grave flow of blood happens infrequently. The patient experienced abdominal ache and a burning feeling when emptying the bladder (Bickley, Szilagyi, and Bates 321). These indicators are normally insignificant and slowly fade after the cystoscopy. Hardly ever, cystoscopy can bring microbes into the patients urinary tract, producing a contamination. To avoid infection, the doctor might propose antibiotics to take prior to and subsequent to the patients cystoscopy. In this case study, the patient was exposed to the urinary tract infection, and his treatment should embrace numerous nursing interventions.

In the case of the serious pain correlated to the infection of the urethra, bladder, and other urinary tract functional parts, the goal is to decrease or dispose of the pain and control the contractions. The nurse should trace the urine dye color and patients pattern of bladder emptying (Jarvis 483). The nurse should also repeatedly analyze the outcomes of urinalysis. This should be done to recognize the signs of improvement or peculiar properties concerning the expected results. The nurse should apply measures, such as massage with the purpose of instigating relaxation and minimizing the patients muscle stiffness. Another option might be the introduction of perineal care in order to avoid infection of the urethra.

The patient should pay attention to the fun with the object of avoiding the feel of discomfort and pain. The patient might be introduced to the collaboration of pain relievers with the purpose of controlling the pain. In the end, the patient should report no discomfort on urination and no aching in the lower pelvic region (Reteguiz 332). If the case is the reduced urinary elimination linked to recurrent urination, perseverance, and diffidence, the goal would be to recover the voiding pattern. As a result, the patient should report a decrease in urination regularity. The intervention, in this case, should comprise the evaluation of the patients voiding pattern. It would be reasonable to reassure the patient to reduce water (or any other liquids) drinking after lunch.

The purpose of this approach is to maintain the renal blood stream and take out the germs from the urinary tract. The fluids that annoy the bladder should be evaded. This is done with the aim of not waking up regularly at night to void the bladder. An essential part of this approach is to motivate the patient to void the bladder every 2-4 hours (Reteguiz 332). The reason for this is the fact that it expressively reduces the number of germs in the urine and averts the reappearance of contamination.

Another issue that the patient may confront is the distressed sleep pattern associated with discomfort and nocturia. The nurse should recognize the typical sleeping behaviors in order to detect suitable interventions. Another strong point is to provide the patient with a cozy bed as it would capitalize on sleeping relief and support him both physically and emotionally. It is of the essence to diminish noise and light in order to create an atmosphere beneficial to sleep.

These measures should help encourage healthy and enjoyable sleep that has a great impact on the patients health (Reteguiz 332). The medical workers should pay attention to the hyperthermia consistent with the response to irritation. They should also react to any instance of amplified body temperature or the appearance of patients complaints. It is crucial to supervise the dynamic signs, specifically temperature, as designated so as to elaborate the interventions. The use of bandages (sprinkled with warm water) on the temple and both axillae is also defined as a way to rouse the hypothalamus. Antipyretic medications may also help in controlling fever.

Works Cited

Bickley, Lynn S., Peter G. Szilagyi, and Barbara Bates. Bates Guide to Physical Examination and History Taking. 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2012. Print.

Chernecky, Cynthia C., and Barbara J. Berger. Laboratory Tests and Diagnostic Procedures. 6th ed. St. Louis: Saunders Elsevier, 2012. Print.

Gingell, Clive, and Paul Abrams. Controversies and Innovations in Urological Surgery. London: Springer, 2012. Print.

Jarvis, Carolyn. Physical Examination & Health Assessment. 7th ed. St. Louis: Saunders Elsevier, 2016. Print.

Kumar, Parveen J., and Michael L. Clark. Kumar & Clarks Clinical Medicine. Edinburgh: Saunders/Elsevier, 2012. Print.

Reteguiz, Jo-Ann. Mastering the USMLE Step 2 CS (Clinical Skills Examination). 3rd ed. New York: McGraw-Hill, Medical Pub. Division, 2005. Print.

Introduction

The practice that aims at promoting health by providing individuals with the opportunity to perform important and helpful tasks is called occupational therapy. The professionals in this fieldwork with individuals who suffer from different disabling conditions. Such individuals include the mentally challenged, the physically challenged, those with developmental problems and emotional issues. They provide avenues that ensure that the client fully recovers and maintains good health.

Article review

The articles provided show aspects of occupational therapy and what therapists are doing to ensure that the unfortunate individuals lead a better life. The Canadian Association of Occupational Therapists (COAT) is one such organization that aims at enriching the lives of such individuals by providing solutions to some of the challenges facing them. For example, they recommend that health information should be written in plain language (rather than sophisticated literature) to support equitability in the access of health information by all individuals. This would ensure that even those individuals who have low literacy levels would be able to comprehend easily and get assistance like the literate ones.

COAT has developed strategies to address the issue of communication problems by advocating the use of simple (plain) language in the presentation and organizing of the health information. This body of professional therapists recognizes that illiteracy or low literacy is a major threat to the health of Canadians. The older adults are the main victims of this unfortunate happening. Through occupational therapy, the therapists ensure that the individuals are assisted in the understanding, interpretation and application of the written and oral information. This is necessary for the clients to go through the day-to-day tasks effectively. This also helps them become independent and have good self-esteem.

The organization ensures that all its written material reaching the general public is in plain language and can be easily understood by even the less literate. To be aware of their level of literacy, the organization ensures that it collaborates with clients of all kinds and identifies techniques that would help make communication easier. They have discovered that the use of clear verbal communication enables clients to understand health information much more easily. COAT has understood the link that exists between health and literacy and has formed partnerships with other bodies to raise awareness about this issue. This would make the occupational therapists and other related professionals knowledgeable on this issue and make their work easier and more effective.

Being literate in terms of Health care means being able to read, interpret and act upon health information. Those people who have low literacy skills face problems when trying to access health information and services. There are also the indirect effects of low literacy. They include unhealthy living conditions, poverty, unhealthy environments and high-stress levels. However, COAT has made their work easier by ensuring that all health information is written and communicated in plain language for all individuals from different cultures, ages and geographic locations to comprehend and access health facilities.

Conclusion

Ensuring perfection for all is important for any nation. Different individuals have different abilities, and this affects their levels of health. Those who are literate and can understand health information can access health facilities and get assistance. However, those who have low literacy levels may have problems understanding some of the written health information. Therefore, occupational therapy is necessary to ensure equity in access to health services. COAT has ensured this by ensuring that all health information is written and communicated in plain language and clear verbal communication.

References

ABC Canada. (2005). International Adult Literacy and Skills Survey (IALSS). Report summary. ABC Canada, 1-5.

Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. (1999). Health literacy: Report of the Council on Scientific Affairs. Journal of the American Medical Association, 281(6), 552-557.

Canadian Public Health Association (1998). Easy Does It! Plain Language and Clear Verbal Communication Training Manual. Ottawa, ON: CPHA.

Government of Canada (1999). Toward a Healthy Future. Second report on the health of Canadians. Ottawa, ON: Health Canada Publications.

Griffin, J., McKenna, K., & Tooth, L. (2006). Discrepancy between older clients ability to read and comprehend and the reading level of written educational materials used by occupational therapists. American Journal of Occupational Therapy, 60(1), 70-80.

Human Resources and Skills Development Canada and Statistics Canada. (2005). Building on our Competencies: Canadian results of the International Adult Literacy and Skills Survey (IALLS). Web.

National Literacy and Health Program. (2006). NLHP Literacy and health fact sheet. Ottawa, ON: Canadian Public Health Association.

Public Health Agency of Canada. (2003). How does literacy affect the health of Canadians? Web.

The heart is one of the most important muscles in the body. It can pump blood through synchronized contractions. Normal heart rate ranges between 60-100 beats in a minute when a person is resting (Heart Rhythm Society, 2005). Contraction and relaxation of the heart to pump blood are stimulated by an electric current that originates from the atria part of the heart called the sinus node and atrioventricular node which make the heart contract and pump blood. The purpose of this paper is to define the term atrial fibrillation, explain the various classification of atria fibrillation, its signs and symptoms, causes, diagnosis and treatment.

Atrial fibrillation is a condition that occurs when an electric current is generated in the heart from all parts of the atria at a high speed of between 300 to 500 impulses per minute (Heart Rhythm Society, 2005). This causes atria to fail to contract in a coordinated way. This high rate of impulses generated causes atria to quiver or fibrillate. Consequently, ventricles start to contract independently from atria causing increased heart rate. The resulting irregular heartbeats at a very high rate may cause some blood to be retained in the heart after every contraction. Such pooling of blood in the heart can increase the risk of blood clot formation and eventual cause stroke (Heart Rhythm Society, 2005).

There are three classifications of atrial fibrillation. The first one is called paroxysmal atrial fibrillation which is characterized by irregular heart rhythms that last for a short time and are clear without any intervention. The second classification is known as persistent atrial fibrillation. Patients with this type of atrial fibrillation have arrhythmia for a significantly long period. The last one is called chronic or permanent atrial fibrillation which is characterized by constant arrhythmia events (Ibid).

Though some people may have atrial fibrillation without apparent cause, several risk factors predispose individuals to this condition. Such risk factors include high blood pressure, diabetes, thyroid disease, chronic lung disease, mitral valve disease and openheart surgery. Also, it has been found that advanced age is a risk factor for atrial fibrillation. Certain unhealthy lifestyles like excessive alcohol consumption and the use of stimulating drugs such as decongestants, caffeine and cocaine also can lead to atrial fibrillation (Heart Rhythm Society, 2005).

Symptoms associated with atrial fibrillation may include shortness of breath upon exertion, frequent palpitations, chest pain, episodes of dizziness or lightheadedness and fainting. However, to some individuals, there may be no symptoms. Diagnosis for atrial fibrillation involves taking of medical history and careful examination. Electrocardiogram (ECG) is a commonly used medical device to diagnose atrial fibrillation. It has sensors that are placed on the chest, legs and arms to detect and provide a record of the hearts electrical activity. Since atrial fibrillation may not occur during ECG examination, a patient may be requested to wear a portable ECG called Holter monitor for one or two days to have sufficient sampling data on heart rhythm (Heart Rhythm Society, 2005).

Treatment of atrial fibrillation anchors on three main objectives. The first one is the restoration of normal heart rhythm. When atrial fibrillation is not rectified in time can cause permanent heart damage. The second objective is to slow the heart rate and provide relief to some or all associated symptoms without rectifying irregular heart rhythm. The final objective focuses on avoiding blood clotting that may lead to stroke by the use of anticoagulant drugs. Calcium channel blockers and beta-blockers are used to control heart rate. Electrical cardioversion provides an alternative treatment when medication fails. It involves the provision of electric shock to the heart to rectify its irregular rhythms. Another option is the use of pacemaker therapy. This is where the peacemaker device is implanted to monitor heart rate. It also stimulates the heart when its rates become slow (Heart Rhythm Society, 2005).

Reference

Heart Rhythm Society (2005). What is atrial fibrillation? Web.