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Coronavirus pandemic issues are on daily headlines in social media, and in every conversation, it has made it a worldwide crisis, with the United States, not an exception. Coronavirus’s high infection rate, socio-economic impact, high mortality rate, international and national awareness, and concern have made the disease a public health crisis needing immediate actions to stop the detrimental effects. The policymakers have been involved in finding a solution to the pandemic worldwide. In the United States, Trump and Biden’s administration deployed measures to curb the spread of the virus. The assignment compares these two presidential administration actions to resolve the disease. A fact sheet to communicate the healthcare issue to policymakers is also attached.
The other President’s response to the epidemic was to lock the country’s borders and stop the virus from entering the country. On 31st January, President Trump issued an executive order suspending entrance from China, followed by others subsequently. Unfortunately, with local disease spread already ongoing in the United States and difficulties screening incoming travelers, travel restrictions proved ineffective in slowing the spread of the virus in the United States (Kates et al., 2020).
After a spike in the number of people infected with the coronavirus, the President issued social distancing measures and stay-at-home directives to combat the virus’s spread (Kates et al., 2020).
The President also approved four emergency spending acts enacted by Congress, which provided trillions of dollars to combat COVID-19 and provide unprecedented flexibility and relief to individuals, corporations, states, and municipal governments. He has put the Defense Production Act (DPA) to expand production, prioritize, and allocate supplies in the United States.
He implemented a national emergency response strategy to stop the virus from spreading, safeguard frontline workers, and save lives. He proposed a plan to encourage the federal government to take the lead in COVID-19 response tactics such as managing healthcare supplies used to control and treat coronavirus, contact tracing, and expanding coronavirus testing capacity (Kates et al., 2020).The President assumed responsibility for ensuring that crucial supplies were delivered to the state and tribes. The Defense Production Act was enacted to improve the production of face masks and other equipment such as ventilators to increase supply, particularly in hard-to-reach places.
Biden also encouraged the Americans to wear masks in public places and maintain social distance to minimize the disease spread.
Biden has also called for legislation to extend financial support to individuals, education institutions, and businesses beyond what’s approved by Congress or endorsed by the government and improve insurance coverage to assist states in delivering COVID-19-related services and completely eradicate cost-sharing for COVID-19 treatment (Kates et al., 2020).
The President also encouraged people to get coronavirus vaccines in large numbers. He made sure the vaccines were available in most places to cover a large population vaccinated.
Biden also established international engagements to support the fight against Covid-19 ((Kates et al., 2020).
Identify the allocations of resources that the current and previous presidents dedicated to this issue.The President allocated medical supplies through the Defense Production Act. The medical supplies included ventilators and personal protective equipment to prevent the spread of the virus (Maves et al., 2020).He also allocated money to combat coronavirus by approving the emergency spending acts ((Kates et al., 2020).
The President allocated finances to use in treating coronavirus
He also allowed coronavirus vaccines in the country to control the disease. Many people were vaccinated over a short period, thus minimizing the disease spread.
He also provided critical medical supplies such as personal protective equipment, masks, and ventilators (Maves et al., 2020).
Center for disease control and prevention (CDC) would help address the public’s disease. Covid 19 being a worldwide epidemic, CDC has been at the forefront of providing prevention measures guidelines. The agency is also involved in delivering covid 19 testing services to the public. It gives recommendations on the issuance and use covid 19 vaccines and has a V-safe that track any side effect or adverse effect associated with the use of the vaccines. This agency detects any variant of covid 19 available, disseminating the information worldwide (Christie et al., 2021).
Center for disease control is an essential agency as it provides the public with all the information concerning covid 19, such as its variant, prevention guidelines, and vaccinations. It develops the covid 19 testing agents such as polymerase chain reaction test and equips other laboratories to perform the test. Without the agency, we would not understand the changing variants of covid 19, and the mortality rate would be high. Misinformation and fear would still prevent the public from knowing the actual means of disease prevention and the functionality of covid 19 vaccines.
How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?Covid 19 is a worldwide issue. Its effects, such as high mortality rate, high communicability, social and economic impact, national and international concern and regulations, public awareness, and concerns, make coronavirus get into the presidential agenda. It has affected all the continents and was declared a worldwide disaster by the world health organization. Every country has been mandated to enforce covid 19 prevention guidelines to prevent the high mortality rate. Being a global problem, the President has to declare covid 19 a national disaster, which will pave the way for support from other states. The President has to address the nation regularly and provide insight into it to know what is happening. Lack of enough resources, research, and knowledge on managing the disease make it stay on the presidential agenda.Who would you choose to be the entrepreneur/ champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected? An example is Michael J. Fox, a champion for Parkinson’s disease.I would choose Dr. Rochelle Paula Walensky, the director for the Centers for Disease Control and Prevention and the administrator of the Agency for Toxic Substances and Disease Registry in the United States.
Epidemiology
The pandemic affects all people, ages, and all genders. The entire population is susceptible to coronavirus; thus, everyone is at risk until herd immunity is established. The infection rate is high, especially the secondary attack rate. The mean serial interval (the period between onset of symptoms) is 4 to 5 days (Dhar Chowdhury & Oommen, 2020).
Physical, economic, psychological, and social effects
Coronavirus causes respiratory complications and advances to major body organs.
It also causes depression, anxiety, and stress among the health workers handling Covid-19 patients and among the relatives of covid 19 infected people.
Economically, covid 19 has negatively affected the country’s economy because most resources prevent and treat the virus. With the disease’s high infection and mortality rate, the critical hospital supplies are quickly depleted, rendering the state economically unstable. Most of the funds are used to produce and purchase tools for covid 19 treatments. Managing the disease is costly for individuals and the government. The virus causes social effects by preventing the physical interaction of people due to social distancing.
Mortality and morbidity rate
Different coronavirus variants have different transmission rates, with the Omicron variant being highly transmissible compared to the Delta variant. The Omicron variant was identified in November 2021. As of 20th December 2021, the average death attributed to coronavirus was 1300 per day in the United States and 70000 admissions even with coronavirus vaccine (Del Rio et al., 2022).
Prevention and early diagnosis
Nurses can play a significant role in detecting coronavirus infected person through screening, isolating the person to prevent further spread, and doing contact tracing. Therefore, they can treat the patient or refer them for further management (Anders, 2021).
Disease notification
Since nurses are at the forefront in testing and managing coronavirus, they can report disease cases as they occur for planning and resource allocation (Anders, 2021).
Advocacy
Nurses can advocate for the provision of personal protective equipment and medical machines such as ventilators for use in virus management.
They can also advocate for quality, cost-effective and accessible healthcare services to manage covid-19 cases (Anders, 2021).
They can also advocate for new coronavirus management standards if they do not produce positive outcomes since they interact with patients daily.
In the United States, the Trump administration and the Biden administration were involved in finding a solution to the Covid-19 pandemic. The two presidential administrations had effective agendas and strategies to address the healthcare issue. Biden’s administration strategies were the best of the two presidential administrations since they were organized and the government was at the forefront, giving guidelines to take as a state. The best agency to address the issue is the Center for disease control and prevention, with Dr. Rochelle Paula Walensky as the director.
The disease epidemiology, social and economic impacts, high mortality rate effectively communicate the disease to policymakers as an urgent disease requiring immediate interventions. The nurses also play an integral role in addressing the healthcare issue since they directly contact Covid-19 patients. They can diagnose the disease, do a report and notify the authorities and advocate for quality services to address the issue.
Use this Agenda Comparison Grid to document information about the population health/healthcare issue your selected and the presidential agendas. By completing this grid, you will develop a more in depth understanding of your selected issue and how you might position it politically based on the presidential agendas.
You will use the information in the Part 1: Agenda Comparison Grid to complete the remaining Part 2 and Part 3 of your Assignment.
Identify the Population Health concern you selected.HIV/AIDS patientsDescribe the Population Health concern you selected and the factors that contribute to it.Human immunodeficiency virus (HIV) is a lentivirus that causes AIDS when not treated. HIV/AIDS is a major global concern due to due to cost, health burden, and deaths attributed to it. Globally, 35 million people are estimated to be living with HIV of which 1.1M are Americans as women form m25% of those infected. Annually, up to 50,000 new diagnoses are recorded in the USA with a prevalence rate of 0.23% (Hiers, 2020). an estimated $20 billion is spent by the USA government for the prevention and care of HIV patients.
Treating and preventing HIV is faced with major threats such as increasing intravenous drug users, increased stigma related to the disease, poor education about safe sex, lack of access to testing kits, preventive measures, and incases to care, and lack of awareness about HIV (HIV Basics, 2021).
Though there is no cure, there is hope to reduce infection rates if basis prevention strategies are put in place. Those preventive measures should be encouraged in those who are at increased risk of contracting and spreading the disease including gay men, intravenous drug users, and commercial sex workers.
Administration (President Name)President Biden President Trump President ObamaDescribe the administrative agenda focus related to this issue for the current and two previous presidents.He empowered initiative for ending the HIV epidemic as championed by President Trump. The agenda is to reduce the HIV infection rate by 75% come 2025.He came up with a campaign called “Ending HIV epidemic in the USA by 2030”. The initiative aimed at reducing HIV infection by 75% by 2025 and 90% by 2030 (HIV Basics, 2021). The main ideas of the agenda are to increase prevention measures, early diagnosis, timely treatment, and appropriate response to the pandemic.He campaigned for the National HIV/AIDS Strategy (NHAS). The goals of the strategy included reducing incidences of HIV, increase access to care, reducing health disparities related to HIV, and improving Coordinated National response (US Preventive Services Task Force et al., 2019).Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.He intends to use $800million to fight HIV in the USA. It is estimated that $25 billion will be used in fighting HIV globally.He allocated $291 million for the agenda. $140 million were allocated to the center of disease prevention to collaborate with other local health sectors to respond to epidemic and increase prevention strategies (Hiers, 2020). $120 million for Health Resources &service administration to provide care to infected individuals through Ryan White HIV program. Other funds were allocated to the at-risk population to access care.$50 billion was allocated to fight the HIV pandemic globally.Explain how each of the presidential administrations approached the issue.The strategies are related to those used to integrate Trump`s and Obama`s initiatives. Increasing testing, linking patients to care, early initiation of care, early diagnosis, and putting prevention initiatives to reduce infection rates.The strategies deployed included encouraging early diagnosis, early treatment, preventing the spread, and responding to outbreak. Early diagnosis is made through providing self-test kits and mass testing. Prevention strategies included providing pre-exposure prophylaxis ( PreP), use of condoms, and providing syringes to intravenous drug users. Additionally, the focus was put on the 40 counties with a high HIV burden.Strategies used included increasing HIV testing and linkage to care, increase awareness education, universal viral suppression through early initiation to care and compliance, access to PreP, offering support to people living with HIV/AIDS, and supporting the Ryan White HIV/AIDS Program (RWHAP). He also implemented the Affordable Care Act to enhance access to care for vulnerable populations (US Preventive Services Task Force et al., 2019).Using the information you recorded in Part 1: Agenda Comparison Grid, complete the following to document information about the population health/healthcare issue your selected
Administration (President Name)(Current President)(Previous President)(Previous President)Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected?The food and Drug Administration (FDA) has a role in regulating the prescription of drugs and other biological therapeutics. Regulations ensure that appropriate medications that have high efficacy are provided to the patients.Department of Human Health Services (HHS) has the major goals of ending opioid use, promoting biomedical research, promoting mental health, and promote equity to access to care for all people. Eradicating opioid use will reduce the transmission of HIV through the limited sharing of needles. The research will help in coming up with new ideas on treating patients are reducing the burden of disease.The Center of Disease Center has a role in coordinating with other local and global health personnel to come up with strategies to prevent HIV infection and respond appropriately to outbreak.How do you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there?HIV/AIDS has led to the death of up to 700,000 in the USA since 1990 (HIV Basics, 2021). If proper measures are not put in place to curb its spread, then more deaths will be reported. It is therefore a major healthcare agenda.HIV/AIDS is a healthcare agenda since over 35 million people living with the condition. Up to 90% of new infection rates are spread by those who are not on care and those who do not know their status.A lot of money and resources are spent on taking care of HIV/AIDS patients. Increasing expenditure in the taking of these patients will mean that other development issues are put a bay.Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected for the current and two previous presidents?I will choose Bill Gates and Melinda as champions for coming up with a foundation that offers HIV grants to help in caring and preventing infection spread, the foundation offers over $3 billion grants.I will choose president trump himself for coming up with a strategy to eradicate HIV by increasing preventive strategies, increased treatment of those affected, offering quick response where needed.I will choose president Obama himself as the champion as had a vision of eradicating HIV globally by working with other agencies. Implementing the affordable care act ensures that even the vulnerable population can access care.Note Part 3: of Module 1: Assignment: Agenda Comparison Grid and Fact Sheet or Talking Points Brief is a 1-page Fact Sheet or Talking Points Brief the you will create in a separate document.
HIV/AIDS is a global pandemic that has resulted in the death of many people. Its burden in terms of death, cost of care, and mobility put it on the global map as a health care burden therefore addressed by every aspirant in elections. HIV/AIDS is transmitted through unprotected sex, exchange of body fluids, sharing sharp objects including syringes by intravenous drug users, and transmission from mother to child (HIV Basics, 2021). There is no known cure, however, prevention can help in reducing new cases.
Previous and current presidents have been putting up strategies to help in eradicating and reducing rates of infections. For example, Trump came up with an initiative to end the HIV pandemic by 2030 (Hiers, 2020). The goals of the strategy focused on prevention, diagnosis, treatment, and response to the pandemic. Intravenous drug users were targeted in this strategy as they were deemed vulnerable to infection transmission.
There was a strategy to provide free syringes to intravenous drug users to reduce the rate of infection. On the other hand, President Obama came up with NHAS that aimed at reducing infection rates, improving access to care, early treatment, and increased viral suppression. His strategies were aimed to not only help America but also developing nations. President Biden integrated the ideas by both Obama and to ensure the eradication of HIV.
HIV/AIDS is a preventable disease that requires support from all healthcare workers to ensure that the pandemic is curbed. Nurses like other health care workers are at the forefront of fighting the pandemic(HIV Basics, 2021). Nurses can offer education to the general population on how to prevent the spread of HIV using strategies such as using condoms, being faithful, safe use of syringes by intravenous drug users. Additionally, they can provide education regarding the use of PrEP for those at risk.
Explain how each of the presidential administrations approached the issue of COVID-19/Pandemic
Identify the allocations of resources that the two presidents dedicated to this issue. The response clearly and accurately explains how the presidential administrations approached the issue and identifies the resource allocations dedicated to the issue.
Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency most helpful?
How do you think your selected healthcare issue might get on the agenda? How does it stay there?
Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected and justify your selection.
The response clearly and accurately identifies an administrative agency most likely to be responsible for addressing the selected healthcare issue and why that agency is most helpful.
Response clearly and accurately explains how the healthcare issue gets on the agenda and remains there.
The response clearly and accurately identifies and justifies the entrepreneur/champion/sponsor of the healthcare issue selected.
Based on your Agenda Comparison Grid for the healthcare issue you selected, develop a 1-2-page narrative that you could use to communicate with a policy- maker/legislator or a member of their staff for this healthcare issue.
Summarize why this healthcare issue is important and should be included in the agenda for legislation.
Justify the role of the nurse in agenda setting for healthcare issues
Creates an accurate and thorough fact sheet.
Using sufficient evidence, the response provides an accurate synthesis of evidence on why this healthcare issue is important and should be included in the agenda for legislation.
Response accurately justifies the role of the nurse in agenda setting for healthcare issues.
Use this Agenda Comparison Grid to document information about the population health/healthcare issue your selected and the presidential agendas. By completing this grid, you will develop a more in depth understanding of your selected issue and how you might position it politically based on the presidential agendas.
You will use the information in the Part 1: Agenda Comparison Grid to complete the remaining Part 2 and Part 3 of your Assignment.
Identify the Population Health concern you selected. Describe the Population Health concern you selected and the factors that contribute to it. Administration (President Name) Describe the administrative agenda focus related to this issue for the current and two previous presidents. Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue. Explain how each of the presidential administrations approached the issue.Using the information you recorded in Part 1: Agenda Comparison Grid, complete the following to document information about the population health/healthcare issue your selected
Administration (President Name)(Current President)(Previous President)(Previous President)Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected? How do you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there? Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected for the current and two previous presidents?Mental health is a healthcare issue of paramount importance, deserving a prominent place on the legislative agenda for several compelling reasons. Firstly, mental health conditions are pervasive, affecting a substantial portion of the U.S. population. According to the National Alliance on Mental Illness (NAMI), one in five adults in the United States experiences a mental illness in any given year (Drew & Martin, 2021). This prevalence underscores the widespread nature of the problem and its potential impact on millions of lives. Beyond the human suffering caused by mental health disorders, there are significant economic ramifications. The costs associated with untreated or under-treated mental illnesses are substantial, including lost productivity, increased healthcare expenditures, and strain on social services.
By addressing mental health comprehensively, lawmakers have an opportunity to not only alleviate the suffering of individuals but also to mitigate the financial burden on the healthcare system and society as a whole. Furthermore, mental health is interconnected with numerous other aspects of society. It influences educational outcomes, workplace productivity, and public safety. Neglecting mental health issues can exacerbate related problems such as homelessness, substance abuse, and involvement with the criminal justice system. This interconnectedness underscores the need for a holistic approach to healthcare policy that considers mental health as a central component.
Nurses are pivotal in the agenda-setting process for healthcare issues like mental health. They are on the frontline of healthcare delivery, providing daily care to individuals with mental health conditions. This frontline experience grants them unique insights into the challenges and gaps in mental healthcare services (Morales et al., 2020). Nurses witness the consequences of inadequate mental health support and can provide valuable input on the policies needed to address these shortcomings (Murdy et al., 2023).
Nurses’ expertise in patient care and their understanding of the broader healthcare system makes them credible advocates for mental health issues. They can articulate the specific needs of patients, advocate for improved access to mental health services, and stress the importance of prevention and early intervention. Their voices resonate with policymakers, reinforcing the urgency of including mental health on the legislative agenda.
Chan, S., Li, L., Torous, J., Gratzer, D., & Yellowlees, P. M. (2019). Review and implementation of self-help and automated tools in mental health care. Psychiatric Clinics, 42(4), 597–609. https://doi.org/10.1016/j.psc.2019.07.001
Drew, J. M., & Martin, S. (2021). A national study of police mental health in the USA: Stigma, mental health and help-seeking behaviors. Journal of Police and Criminal Psychology, 36(2), 295–306. https://doi.org/10.1007/s11896-020-09424-9
Farber, G. K., Gage, S., Kemmer, D., & White, R. (2023). Common measures in mental health: A joint initiative by funders and journals. The Lancet Psychiatry, 10(6), 465-470. https://doi.org/10.1016/S2215-0366(23)00139-6
Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463–467. https://doi.org/10.1017/cts.2020.42
Murdy, A. (2023). Mental health in the USA—a time to mourn. The Lancet Child & Adolescent Health, 7(2), 89. https://doi.org/10.1016/S2352-4642(22)00310-8
Most citizens often grow concerned when considering whether the interests of the government work in favor of the topics of interest to them. The healthcare system is no different. Some individuals feel federal, local, and state policies and legislation may either benefit society or be hindered by their interests.
To prepare for this module, you need to analyze the learning resources and reflect on the efforts to replace or repeal the Affordable Care Act (ACA). Evaluate who benefits the most from this policy development and implementation.
As a nurse, it’s important to realize that there is a lot you can do to make things work differently in the healthcare system. You have a role and a voice, so most nurses are beginning to venture into advocacy. This hopes to impact policies, laws, and regulations that affect healthcare issues. Although most nurses are skeptical about diving into the unfamiliar world of policies and politics, the reward is the opportunity to influence future health policies.
To prepare for this Assignment, you need to select a proposed bill (not one that has been enacted) from the learning resources provided. The Assignment comprises two parts, the Legislation grid and the Legislation testimony/advocacy statement.
This is a one-to-two-page paper whereby you will use the proposed bill you selected to complete the grid. Address the following:
Based on the information you acquired from the proposed bill you selected, address the following:
Boards of Nursing (BONs) exist in all 50 states, American Samoa, the District of Columbia, the Virgin Islands, Guam, and the Northern Mariana Islands. BONs aim to protect the public through the regulation of nursing practice. These boards highlight state/region regulations that all nurses must follow to get licensed.
These regulations may differ from one state/region to another. It’s essential to compare these regulations. This helps nurses who may require licenses in multiple areas or states. It also helps share insights that can be useful in case of future changes in a state/region.
Nursing is a profession with various regulations. There are over 1000 nursing boards and national nursing associations across the United States. They aim to regulate, promote, and inform the nursing profession. Due to the large number of these entities, it’s challenging to distinguish between a BON and a national nursing association. It’s also difficult to evaluate the benefits and options offered by each.
Both of these bodies significantly impact the nursing profession and scope of practice. Once you understand the differences, you can build your expertise as a professional. In this Assignment, you need to compare the boards of nursing and national nursing associations. You must also provide an analysis of your state’s BON.
To prepare, you will assume you are the head of a staff development meeting on nursing practice regulation at your healthcare agency. Evaluate the ACA and the NCSBN websites to prepare for your presentation.
The use of telemedicine in the United States of America (USA) is currently at an increasing rate. According to Kichloo et al. (2020), US hospitals and other healthcare institutions are increasingly adopting telemedicine into their systems partly due to the proliferation of computer technology as well as several other benefits associated with it. However, while the popularity of telemedicine is growing, there are a few challenges that are still associated with it. This essay outlines the challenges as well as the benefits of telemedicine.
Baiowala et al. (2020) define telemedicine as a telecommunication technology that enables health organizations to examine and diagnose patients from a distance. Telemedicine has been touted as a revolutionary approach to remote delivery of health and social care services especially when patients and service providers cannot meet physically for purposes due to certain constraints (Dorsey & Topol, 2020). Below are some of the advantages of telemedicine.
Integrating the latest telemedicine systems into a hospital’s operations can enable more accessible and convenient patient care. According to Karyagina & Sitdikova (2019), providing easy access to healthcare services is one of the ways of promoting patient satisfaction because it enables a personalized approach to care delivery thus enhancing patient-centered care.
Today, convenience is one of the key factors considered by service users when consuming healthcare services and therefore patients are more likely to be satisfied by convenient care. adding a virtual aspect to care delivery offers simple, on-demand care with reduced time and cost wastage associated with in-person visits (Rimmer et al., 2018). Patients who live remotely or those who cannot take a leave from work can easily access visual care services through telemedicine. Smartphone apps, online management systems and videoconferencing technology can now easily be used to connect patients with their care providers than ever before.
Telemedicine can also help save costs of care. It enables remote service analysis and monitoring as well as data storage techniques that ultimately save on service costs for the hospital, the patients, and the insurance providers (Contreras et al., 2020). Apart from the cost savings, telemedicine can also enhance providers’ revenue by turning on call-time into billable hours, as well as reducing no-shows, or reducing the cost of care providers who would like to be more flexible with their service delivery.
Whereas telemedicine can present all the above benefits, it still has a few practical problems and challenges for healthcare providers. For instance, purchasing and training employees on IT equipment can be costly and time-consuming. According to Kichloo et al. (2020), nurses, physicians, health supervisors and managers must be trained on the new system to optimize the system’s return on investment.
Telemedicine has also been accused of reducing care continuity. As per Baiowala et al. (2020), on-demand telemedicine services enable patients to connect to different care providers, and this may discontinue the provision of care that had begun with a different practitioner. Typically, a patient’s primary care provider may not have access to the patient’s records from other visits and this leads to incomplete patient history.
Adding telemedicine to a hospital organization is a significant move towards enhancing the efficiency and quality of care. Through telemedicine, patients can conveniently access care. it is also associated with reduced cost wastage associated with in-person visits. It enables remote service analysis and monitoring as well as data storage techniques that ultimately save on service costs for the hospital, the patients, and the insurance providers. However, purchasing and training employees on the IT equipment can be costly and time-consuming, something that healthcare facilities must contend with today.
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.
You should not be using systematic reviews for this assignment, select original research articles.
Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.
Part 1: An Introduction to Clinical Inquiry
Create a 4- to 5-slide PowerPoint presentation in which you do the following:
Part 2: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
Use this document to complete Part 2 of the Module 2 Assessment, Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry, and Part 2: Research Methodologies.
Full citation of selected article Article #1 Article #2 Article #3 Article #4
Why you chose this article and how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical topic of interest)
Brief description of the aims of the research of each peer-reviewed article
Brief description of the research methodology used: Be sure to identify if the method used was qualitative, quantitative, or mixed methods. Be specific.
A brief description of the strengths of each research methodology used, including reliability and validity of how the process was applied in each of the peer-reviewed articles you selected.
General Notes/Comments
Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research Methodologies
Full citation of selected articleArticle #1Article #2Article #3Article #4Wee, L. E. I., Conceicao, E. P., Tan, J. Y., Magesparan, K. D., Amin, I. B. M., Ismail, B. B. S., Toh, H. X., Jin, P., Zhang, J., Wee, E. G. L., Ong, S. J. M., Lee, G. L. X., Wang, A. E., How, M. K. B., Tan, K. Y., Lee, L. C., Phoon, P. C., Yang, Y., Aung, M. K., Sim, X. Y. J. and Ling, M. L. (2021). Unintended consequences of infection prevention and control measures during the COVID-19 pandemic. American Journal of infection control, 49(4), 469–477. https://doi.org/10.
1016/j.ajic.2020.10.019
Marx, J. F., Callery, S., & Boukidjian, R. (2019). Value of certification in infection prevention and control. American Journal of Infection Control, 47(10), 1265-1269. https://doi.org/10.1016/j.ajic.2019.04.169
Munoz-Price, L. S., Bowdle, A., Johnston, B. L., Bearman, G., Camins, B. C., Dellinger, E. P., Geisz-Everson, M. A., Holzmann-Pazgal, G., Murthy, R., Pegues, D., Prielipp, R. C., Rubin, Z. A., Schaffzin, J., Yokoe, D., & Birnbach, D. J. (2019). Infection prevention in the operating room anesthesia work area. Infection control and hospital epidemiology, 40(1), 1–17. https://doi.org/10.1017/ice.2018.303
Rutala, W. A., & Weber, D. J. (2019). Best practices for disinfection of non-critical environmental surfaces and equipment in health care facilities: A bundle approach. American Journal of Infection Control, 47S, A96–A105. https://doi.org/10.1016/j.ajic.2019.01.014
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)This article relates to the selected issue of interest (infection control and patient safety) since it helps understand the impact that the infection prevention and control measures that were used for Covid-19 had on other hospital-acquired infections.The research was reviewed and approved by the institution’s review board. It also respected human subjects by ensuring autonomy, privacy, and respect for human dignity.
I chose this article to create an understanding of the clinical issue of infection from the perspective of the infection control prevention professionals themselves, the healthcare workers.The article relates to the clinical infection control issue since understanding healthcare workers’ perceptions of infection control would help improve the current infection prevention and control practices.
The autonomy and privacy of the participants were maintained.
The major reason for selecting this article is because it focuses on infection prevention in the operating room, one of the major areas of infection. Infections in this environment pose a major threat to patient safety.Research ethics was maintained through respect for the human dignity of the study participants.
The reason for selecting this article is because non-critical environments, surfaces and equipment in healthcare facilities also potentially infect patients and care providers. However, more infection prevention and control focus is given to critical environments. Autonomy and privacy were ensured for the study participants. The research results were also shared with participant facilities to ensure research ethics. Brief description of the aims of the research of each peer-reviewed articleThe aim of the research was to evaluate the impact of infection prevention and control measures originally designed for Covid-19 on other hospital-acquired infections.The main aim of the research in the article was to determine the perception of infection control professionals and other stakeholders on the certification of infection prevention and control in institutions. Thus supporting and enhancing certification.This study aimed to identify infection prevention best practice guidelines that can be used in the operation environment to promote patient safety. Current guidelines were reviewed to produce a new guidance statement. The aim of this research was to compile a comprehensive approach to facilitate effective surface cleaning and disinfection in healthcare facilities.Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.The research methodology used in this article is quantitative. The data collected is numerical and statistical analysis. The incidence-rate-ratio was used to compare the rate of hospital-acquired infections after using the new infection prevention and control measures.The research methodology in this article is a mixed method. Data was collected and analyzed using both qualitative and quantitative methods, including interviews and surveys. The quantitative data were analyzed using the Likert scale, while the qualitative data used thematic analysis. The research methodology used in this article is qualitative. The research team made observations on the healthcare professionals working in the operating room. The data was analyzed using content analysis.The research methodology in this article is mixed. Data was collected from different healthcare facilities using surveys. The surveys contained quantitative and qualitative data, which were analyzed using descriptive and thematic analysis.A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.The methodologies used in this article enhanced the objectivity and accuracy of the results since few variables were involved. The other strength is that the analysis was expressed clearly, thus creating more reliable results. The incident-rate-ratio is a reliable and valid measure when comparing infection rates.The mixed methodology used in this article allowed perspectives from both qualitative and quantitative data, thus, more detailed results. It also provided generalizable, easily applicable data. The research tools were tested to ensure validity and reliability before the actual data collection. The research methodology and observation made the research work easier for the researchers. The other strength is that the observation method enabled the researchers to capture new practices. The reliability of the observation was ensured by comparing observers’ results. The validity application is not mentioned. The mixed methodology enabled the researchers to gain deeper insight into the issue by collecting both qualitative and quantitative data. In addition, the data collected was easily replicable and easy to compile to the comprehensive bundle approach containing best practices.General Notes/CommentsThe new multimodal infection prevention and control measures developed for Covid-19 were advantageous for other hospital-acquired infections.
The infection prevention and control strategies should continue even after the pandemic.
Healthcare professionals, who are the major stakeholders in infection prevention and control in their institutions, support infection control best practices. Healthcare stakeholders believe all healthcare providers should have infection control skills.The article supports infection control and prevention best practices.Infection prevention practices should be more rampant in the operating environment.
The compiled bundle entailed creating policy procedures, selecting appropriate cleaning/disinfecting products, educating staff, monitoring compliance, and implementing room decontamination technologies. Infection prevention and control measures in non-critical environments are vital.
Also Read: NURS 6052 Evidence-Based Week 6 Developing a Culture of Evidence-Based Practice
Alzheimer’s is a disease that affects the brain and leads to a loss of the functionality and structure of the neurons that form building blocks. As a result, the disease leads to memory loss among a majority of those it affects. The other symptoms associated with the condition include problems with communicating coherently and in a meaningful way, quick shifts in the temperament, loss of personal and social conduct appreciation and withdrawal. The disease over a period physically depreciates the affected body and leads to death as main organs are wasted away (Elio, Schelterns & Feldman, 2011). On average, most individuals succumb to the disease 3 to 9 years after diagnosis.
The causes of the disease are poorly understood but it is generally accepted that genetics have the largest role to play in determining who gets affected by the disease. Other factors that are believed to cause the condition are many forms of depression, or injuries to the brain. As earlier stated, the disease begins by wasting away neurons found in the brain. Degeneration also occurs in other parts like the frontal cortex and leads to the general shrinking of the brain. This paper seeks into Alzheimer’s as a disease that affects a sizeable portion of the population more so the elderly, and evaluate its effects on the society at large (Jeffrey et al, 2018).
Alzheimer’s is a growing social phenomenon because of the demographic changes that have occurred from the beginning of the boomer generation. The condition mostly affects the elderly and is equivalent to dementia. The demographic change that has been occurring in the last few decades has seen two effects. Firstly, a larger section of the population is living longer and increasing the number of people at risk of getting the disease. An aging population also translates to a larger percentage of the population is at risk of getting afflicted by the disease. As a result, the disease has become a large social burden to the community, the health sector and the government because of the increased costs. The social cost of the disease in the United States is estimated to be $100 billion annually (Jeffrey et al, 2018).
Such huge amounts of money that other sectors of the national budget or health budget are transferred to cater for the rising costs of the condition. Additionally, individuals suffering from the disease are not able to contribute to the national economy as a result of their condition, essentially hurting the employment economy. The largest portion of the costs involved with Alzheimer’s is care that the affected have to give over a long period. This means the construction and expanding of institutions that cater to the patients. The in-patient’s model of the care system represents a costly affair for the state and family involved given that it is also labor intensive. For those who choose to have home care, the cost of lost earnings can be a big detriment to the family finances (Jeffrey et al, 2018). .
The financial burden increases the disease takes its toll and the patient can no longer communicate or interact or remember recent happenings. Loss of memory leads to social discomforts and may tear apart at families. The costs and time taken to care for patients of the disease are not fully catered for or covered by these programs. However, the cost already paid at the initial stages stretch any national health fund and may mean that the fund does not cover other areas of interest. In the United States, the disease is ranked as the sixth leading cause of death among the general population. When the figures are narrowed down to reflect its effects on the elderly, the disease becomes the third leading cause of death among that age group (Leon, et al, 2013).
Currently, the disease has no known cure and patients are only given the at most care in a bid to make their lives as comfortable as possible. However, early diagnosis gives the individual and family time to try out options that are on clinical trial. Thus, the disease requires the best medical attendance to prevent more harm (Jeffrey et al, 2018).
The disease is not very well understood concerning its causes or why it only afflicts the older people in society. However, studies have shown the development of the disease with the gradual wasting away of the brain with the aim of better understanding the condition. Through these studies, scientists have been able to link the disease with how the brain changes as one gets older. As earlier stated, the main cause of the disease is thought to be genetics with the likelihood of it affecting people of the same family higher than those of another family without a relative who was once diagnosed with the disease (Leon, et al, 2013). The genetic link between the disease and individuals suffering from it means that it is much harder to treat in the future because it is a genetic disorder. However, it may also mean that it is easier to identify people as a larger risk of conducting the disease.
Research and trials have shown that meditation methods alongside other techniques can progressively help lead to a memory recovery process. Other forms of interventions such as constant brain simulation and repetitiveness can lead to a slowing down of the worst ravages of memory loss. Early diagnosis of the disease leads to treatment that preserves the mental state but only for a short period (Elio, Schelterns & Feldman, 2011). It is important to note that the worst ravages of the disease cannot be stopped. Individuals can, however, join clinical trials to help scientists to understand the condition better and come up with treatment for the condition. Currently, the National Institute of Aging leads the research in finding the answers to the most pertinent questions about the disease.
Alzheimer’s is currently the only condition/disease that scientists do not have a way of either preventing, treating or mitigating its worst effects. Given that it is the third disease in terms of taking away lives, it is quite ironic that research for the disease gets low funding from governments across the world. However, in the United States, the Federal government has increased its funding for research of the disease by a factor of four to currently stand at $2.3 billion dollars. Despite the progress, funding remains still below the amounts sufficient enough to mount a strong enough research network towards finding working solutions for the disease (Leon, et al, 2013). Across the fifty states, funding remains poor and does not form a priority for most health departments in states.
Funding for the research needed cannot depend solely on the Federal government and will need all stakeholders to chip in, more so the private sector. Some of these sector players include industry, venture capital, individual donations, the federal government and singular states. Drug development for the disease has been discouraging for the industry more so with a failure rate of 99%. With the total costs of drug development estimated at five and a half billion dollars ($5.6 billion), and the period it takes to get the green light for trials, the industry has been reluctant to invest large amounts of capital (Leon, et al, 2013).
To put it into perspective, the disease has a larger negative impact, as earlier explained, to the US economy than other ailments and yet gets lower funding when compared to either of them. The annual cost of caring for patients with Alzheimer’s disease changes with the level of the condition. The mild form of the disease costs $20,000 annually, the moderate stage, $34,087 while the severe stage costs $38,102. A middle-class family will struggle to pay the bills and which explains the need for greater federal funding towards the disease (Leon, et al, 2013).
Alzheimer’s Disease is a condition that is not very much into the national consciousness and which given its impact on the overall economy shows the great levels that the government and scientific community need to undertake to make it more visible. The need for a greater conversation regarding the disease is needed primarily because of the funding shortfalls that exist and lead families struggling to balance their books. However, action has to be a multi-pronged approach that includes all the stakeholders to have a greater impact more so on the affected (Leon, et al, 2013). With enough medical strategies put in place, it will be easy to treat Alzheimer disease before growing to chronic stages. Therefore, both federal and state governments should work hand in hand in innovating new treatment approaches against Alzheimer aong other diseases.
Alzheimer’s is a slowly progressing neurologic disease characterised by alterations in the brain leading to the damage and loss of neurons and neuron connections (Butterfield & Boyd-Kimball, 2018). These consequently affect an individual’s power to recall and think, and eventually the person loses his or her ability to live alone without depending on others. Scientists still have not well established the cause of Alzheimer’s disease, but the popular belief is that a variety of factors play a role in developing the disease.
The risk factors of Alzheimer’s disease include:
According to Mace and Robins (2017), individuals suffering from Alzheimer’s experience cognitive symptoms that include mental decline, trouble in comprehension and understanding, delusions, loss of memory, confusion and disorientation. Changes in mood including mood swings and being slow to anger are also present. Hallucinations, depression and disorganized speech are some of the presentations seen in Alzheimer’s disease.
The main cause of the disease is the deposition of extracellular beta-amyloid and the development of intracellular neurofibrillary tangles (Kim et al., 2018). The neurofibrillary tangles prevent the exchange of nutrients and other important compounds between one cell and another and this gradually leads to shrinkage of the brain. The depositing of beta-amyloid and the formation of tangles causes a continuous process that ends in the destruction of the neuronal cells, the loss of synapses and deficiencies in the neurotransmitter, resulting in the development of symptoms associated with Alzheimer’s.
After identifying the risk factors of Alzheimer’s disease, I would assist my patient in reducing the risk of developing the condition. Ensuring that my patients follow a good nutrition plan and following up to ensure that they exercise regularly is one of the ways of preventing the condition since a good diet and exercise are key. Ensuring that my patient quits smoking and reduces or stops alcohol consumption is key in reducing the risk of developing the condition. Ensuring my patient’s compliance to medication and especially medication related to any cardiovascular conditions is also key as cardiovascular complications have been shown to increase the risk of developing Alzheimer’s disease.
CASE ID# Tina Comprehensive Assessment
S.O.A.P. Note
Subjective
Objective
Assessment (diagnosis [primary and differential diagnosis])
Plan (treatment, education, and follow up plan)
ChiefComplaint
What brought you here today (e.g., headache)Pre-employment insurance physical exam
History of Present IllnessChronological order of events, state of health before the onset of CCOnsetMs. Jones came into the clinic today, stating that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. She reported the need to get a pre-employment physical before she can start work. The patient denies any acute problems or concerns. Her last healthcare visit was four months ago. She received her annual gynecological exam and stated that the gynecologist diagnosed her with the polycystic ovarian syndrome and prescribed oral contraceptives at that visit. The patient reports that she is tolerating the new medication well. She has type two diabetes, which she is controlled with diet, exercise, and metformin. The patient reports she began taking metformin five months ago and is compliant with her regimen. She has no medication side effects at this time. She states that she has felt an improvement in her health as of late. Ms. Jones says that she is taking better care of her health and is excited to begin her new career.LocationDurationCharacterAggravating/associated factorsRelieving factorsTemporal factors – other things going onSeverityPast Medical HistoryAdult Illnesses, childhood illnesses, immunizations, surgeries, allergies, current medications
Asthma diagnosed at age 2 1/2. Albuterol inhaler for asthma exacerbations. Her last asthma exacerbation was three months ago. The last time she has been hospitalized for asthma was in high school. No intubations. Type 2 diabetes was diagnosed at age 24. She began metformin five months ago and initially had some gastrointestinal side effects which have since resolved. She monitors her blood sugar once daily in the morning, with average readings around 90. She has a history of hypertension, which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche at age 11. First sexual encounter at age 18. Never pregnant. The last menstrual period was two weeks ago. She was diagnosed with PCOS four months ago. For the past four months, her cycles have been regular (every four weeks) with moderate bleeding lasting five days and is taking the medication Yaz. She is in a new relationship with a male, but sexual contact has not yet been initiated. The patient stated that she plans to use condoms if and when sexual intercourse does occur. Tested negative for HIV/AIDS and STIs four months ago.
Current Home Meds:
• Fluticasone propionate, 110 mcg two puffs BID (last use: this morning)
• Metformin, 850 mg PO BID (last use: this morning)
• Drospirenone and Ethinyl estradiol PO QD (last use: this morning)
• Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago)
• Acetaminophen 500-1000 mg PO prn (headaches)
• Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken six weeks ago)
Allergies:
• Penicillin: rash
• Denies food and latex allergies
• Allergic to cats and dust. When she is exposed to allergens, she states that she gets a runny nose, itchy and swollen eyes, and increased asthma symptoms.
Family HistoryInclude Parents, siblings; grandparents if applicable/known, cause of death, age, pertinent medical illnesses• Mother: age 50, hypertension, elevated cholesterol
• Father: deceased in a car accident one year ago at age 58, hypertension, high cholesterol, and type 2 diabetes
• Brother (Michael, 25): overweight
• Sister (Britney, 14): asthma
• Maternal grandmother: died at age 73 of a stroke, history of hypertension, high cholesterol
• Maternal grandfather: died at age 78 of a stroke, history of hypertension, high cholesterol
• Paternal grandmother: still living, age 82, hypertension
• Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes
• Paternal uncle: alcoholism
• Negative for mental illness, other cancers, sudden death, kidney disease, sickle cell anemia, thyroid problems
Personal/Social HistoryEducation, marital status, occupation, alcohol/drug use, smoking status, sexual history if relevant, exercise, nutrition, religious preference if known
The patient Currently lives with her mother and sister. She plans to move into an apartment within the next month. She is excited to begin her new career in a couple of weeks at Smith, Stevens, Stewart, Silver & company. The patient has a group of friends with well-developed relationships. Tina’s religion is Baptist. She has close ties with members of her congregation, which she views as family. Her support system helps her manage stress and anxiety. She denies ever using tobacco products. States that she used marijuana from age 15 to 21. She denies the use of methamphetamines, cocaine, heroin, or prescription drugs. She occasionally drinks when out with friends but usually just two to three times a month. She reports that she typically only has around three alcoholic beverages when out. The patient says that her diet is much improved. Breakfast usually consists of a fruit smoothie and unsweetened yogurt. Lunch is typically a sandwich on white bread or low-fat pita. For dinner, she typically has a portion of protein and vegetables. For snacks, she consumes carrot sticks and apples. She denies drinking coffee but usually drinks one to two diet sodas every day. She has also improved her activity level lately. She exercises four to five times per week by taking a walk, going for a swim, or participating in yoga.
Review of SystemsGeneral:The patient reports a recent weight loss of 10 pounds due to exercise and an improved diet. The patient denies current frequent illnesses, fevers, chills, night sweats, or other symptoms of concern.Hair, Skin, & Nails:No abnormalities reportedHead:Denies recurring headaches or other abnormalitiesNeck:No abnormalities reportedEyes:Denies recent changes in visionEars:No abnormalities reportedNose:No abnormalities reportedMouth & Throat:No abnormalities reportedCardiovascular:Denies recent sensation of palpitationsRespiratory:Reports improved breathing with maintenance asthma medicationBreasts:No abnormalities reportedGastrointestinal:
Genitourinary:
Reports no nausea, vomiting, pain, constipation, diarrhea, or excessive flatulence. No food intolerances.
Reports no dysuria, nocturia, polyuria, hematuria, flank pain, vaginal discharge, or itching.
Musculoskeletal:Denies pain or other abnormalitiesPeripheral:No abnormalities reportedNeurological:Reports reduced level of stress and improved quality of lifePsychiatric:Denies current thoughts of self-harm, denies thoughts of harming others, denies feelings of depression and denies a sense of anxiousness
Physical ExaminationVital signs:Blood pressure 128/82 mmHg, pulse rate 78 beats per minute, respirations 15 breaths per minute, temperature 99.0 degrees Fahrenheit, and O2 saturation 99% on room air, height 170cm, weight 84KgGeneral Appearance:The patient is a 28-year-old, well-developed, well-nourished female in no acute distress. She is alert and oriented, has good hygiene, and is dressed appropriately.HEENT:Normocephalic and atraumatic. Ears: There is no evidence of any external masses or lesions noted. Eyes: Snellen: 20/20 right eye, 20/20 left eye with corrective lenses. Extraocular muscles are intact. Pupils are round and reactive to light. Conjunctivae are pink and moist. Sclerae are white and anicteric. Nose: Nasal mucosa is pink and moist. The septum is midline. Mouth: Oral mucosa is pink and moist. Dentition is good.Neck:Supple. The trachea is midline. No evidence of thyroid enlargement. There is no jugular venous distention noted. There is no carotid bruits noted. There are no palpable masses.Lymph Nodes:There is no inguinal, axillary, supraclavicular or cervical lymphadenopathy or tenderness noted.Chest:Symmetric. Non-tender to palpation. Clear to auscultation bilaterally. There are no crackles, wheezes, or rhonchi noted. There is no crepitus on palpation. Resonant to percussion throughout. In-office spirometry: FVC 3.91 L, FEV1/FVC ratio 80.56%.Cardiac:Regular rate and rhythm with normal S1 and S2. No murmurs, gallops, clicks, or rubs. PMI at the midclavicular line, 5th intercostal space, no heaves, lifts, or thrills. Bilateral peripheral pulses equal bilaterally, capillary refill less than 3 seconds. No peripheral edema.Abdomen:Obese and benign. No mass, tenderness, guarding, or rebound. No organomegaly or hernia. Normoactive bowel sounds are present. No CVA tenderness or flank mass.Genitourinary:Not assessedSkin:Warm, dry, and well perfused. Good turgor. No lesions, nodules, ulcers or rashes are noted. No onychomycosis. Scattered pustules on the face and facial hair on the upper lip, acanthosis nigricans on the posterior neck.Musculoskeletal:Gait is coordinated and smooth. There is no clubbing, cyanosis, edema, or deformities. Strength 5/5 bilateral upper and lower extremities, without swelling, masses, or deformity and with a full range of motion. No pain with movement. TMJ has a full range of motion. No clicksNeurologic:No focal sensory or motor deficits are noted. Gait is normal. Cranial nerves II through XII are grossly intact. Deep tendon reflexes are intact. Tests of cerebellar function normal. DTRs 2+ and equal bilaterally in the upper and lower extremities. Decreased sensation to monofilament in bilateral plantar surfaces.Psychiatric:The patient is alert and oriented to person, place, and time. Appropriate mood and affect.AssessmentPrimary diagnosis:Physical Exam for Work Health InsuranceDifferential Diagnosis:Asthma, Diabetes Type 2, PCOSPlan1.Continue prescribed medications—albuterol for exacerbations and Flovent for daily maintenance.2.Continue to check sugars daily. Continue Metformin. Educate on the importance of continuing current improved diet and exercise habits to continue health improvement.3.Continue Yaz medication.
Severe acute asthma is a clinical emergency that can easily be managed by various clinical therapies. However, if poorly managed, it can invariably lead to death by cardiorespiratory collapse. Typically, therapeutic management of severe asthma targets to increase air passage through bronchodilators dilation and oxygen supplementation. Ultimately, these therapies should stabilize the patient.
The available treatment options for children with severe acute asthma refractory to SAMA/LAMA combination are limited because the remaining ones are either not safe or are expensive. Nonetheless, the patients must the treated and therefore alternatives such as IV steroids with or without heliox are often used as the most feasible options. Against this backdrop, there are various pieces of research evidence that have confirmed the role of IV methylprednisolone as well as that of heliox in improving severe asthma. However, evidence on the latter is a bit controversial due to its side effects and availability. The current study seeks to unravel the available evidence on the use of IV methylprednisolone or a combination of IV methylprednisolone and heliox in the treatment of severe acute asthma in children between the age of 5-15 years old.
The study takes the form of an annotated bibliography; evaluating the quality of evidence in 8 peer reviewed journal articles. The review will summarize the content of each journal article in terms of its purpose, findings and implications of those findings to the management of severe acute asthma. It is worth noting that all the journal articles have been published within the past five years.
Henderson, M. B., Schunk, J. E., Henderson, J. L., Larsen, G. Y., Wilkes, J., & Bratton, S. L.
(2018). An assessment of asthma therapy in the pediatric ICU. Hospital pediatrics, 8(6), 361-367. DOI: https://doi.org/10.1542/hpeds.2017-0003
Henderson et al. (2017) argue that asthma is one of the most common chronic respiratory condition in children affecting millions of children and continues to be a common cause of Intensive Care Unit (ICU) admission. Bearing this in mind, the authors conducted a study on asthma therapy in pediatric ICU, describing asthma management, evaluating practice evaluation, and describing the resource use during asthma management at the pediatric ICU.
Being a retrospective study single-center cohort study, it involved 262 children of age 2 to 18 years in pediatric ICU treated with asthma from 2008 to 201;1 with data collected through intermountain Healthcare Enterprise Data Warehouse. Majority of the participants only received only the first tier of recommended therapy (inhaled short-acting b-agonists, pre-hopsitalization inhaled ipratropium bromide, systemic corticosteroids and oxygen), while 70% of them did not receive any further respiratory support beyond non-breather mask or nasal cannula mask including inhaled nitric oxide, IV b-agonists, intravenous (IV) magnesium sulfate, inhaled heliox. While heliox were rarely used before or after pediatric ICU, no adverse event was reported on its use.
The study results indicated that most of the patients with severe asthma were treated with only the minimum interventions (i.e. first-tier medication, none-breather or nasal canular mask). These treatments minimized the pediatric ICU length of stay and thus reduced expenses involved in asthma care. these findings confirm that heliox can be used as a treatment therapy for asthma in pediatric ICU with no side effects. Its methodology was effective, and the resultant evidence can be useful in comparing the use of heliox versus the use of a combination of heliox and IV methylprednisolone.
However, the fact that this study was a single-hospital cohort study limits the generalization of its findings. Furthermore, the generalization of the study finding is also limited by the fact that it did not consider specific factors such as patient ethnicity, which was not a representative of the US population.
Doymaz, S., Ahmed, Y. E., Francois, D., Pinto, R., Gist, R., Steinberg, M., & Giambruno, C.
(2020). Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?. Journal of Asthma, 1-10. https://doi.org/10.1080/02770903.2020.1870130
The study by Doymaz et al. (2020) was inspired by the statistics that asthma is a chronic
childhood illness that affects at least 6 million children and by 2017, it was responsible for 863 per every 100,000 deaths in the United States. Furthermore, the authors were motivated by the fact that whereas various intravenous IV corticosteroids are available of the treatment of acute severe asthma, the choice of IV corticosteroids largely depends on physician’s preferences or institution. Against this background, the researchers conducted a study to compare the efficacy of IV methylprednisolone, dexamethasone and hydrocortisone during pediatric ICU admission.
The study took the form of a randomized clinical trial that enrolled patients of 1-12 years old requiring continuous beta-2 agonist treatment.
The randomization was done in three groups: IV Dexamethasone group, IV Hydrocortisone and IV Methylprednisolone. The researchers measured primary outcomes based on durations of beta-2 agonist continuous nebulization treatment. On the other hand, the secondary outcomes were measured by pediatric asthma severity score, maximum dose of beta-2 agonist treatment, need for mechanic ventilation and pediatric ICU and hospital length of stay.
The study findings indicated no difference in efficacy of dexamethasone, hydrocortisone and IV methylprednisolone when used in appropriate doses to treat pediatric asthma. This was demonstrated by a no difference in the various outcome measurements such as B2 agonist maximum dose, pediatric asthma severity score, pediatric ICU length of stay and need for mechanic ventilation. While the generalization of these study findings is affected by the small sample cohort, it produces useful evidence to support the use of IV methylprednisolone in the management of pediatric severe asthma.
Fishe, J. N., Gautam, S., Hendry, P., Blake, K. V., & Hendeles, L. (2019a). Emergency medical services administration of systemic corticosteroids for pediatric asthma: A statewide study of emergency department outcomes. Academic Emergency Medicine, 26(5), 549-551. https://doi.org/10.1111/acem.13660
Systemic corticosteroids have always been administered to children with asthma admitted in the emergency department with the aim of reducing their length of stay. However, as per Fishe et al. (2019a), there is a paucity of research examining the improvement effect of corticosteroids on patient outcomes. In response, the researchers conducted a state-wide study to investigate the emergency department outcomes upon the use of corticosteroids on paediatric asthma.
The retrospective observational cohort study relied on patients whose records remained in Florida’s EMS Tracking and Reporting System with information on emergency department’s outcome of patients between 2011 – 2016. The inclusion criteria were children of age 2-18 admitted in the emergency department with respiratory distress, whose acute asthma exacerbation was indicated by their receipt of albuterol. The study found that the administration of IV methylprednisolone was associated with decreased odds of emergency department discharge. Fishe et al. (2019a) attributed these results to a few reasons. For instance, IV methylprednisolone was only reserved for patients with more severe asthma.
The findings of this study are especially useful in understanding not only the effects of IV methylprednisolone as an emergency department intervention for severe asthma in children, but also the role of severity as a factor to consider when using IV methylprednisolone on pediatric asthma. Nonetheless, this study had several methodological limitations that must be pointed out. For instance, the study only focused on one state and this affects its generalizability to other areas of the United States. Furthermore, only on third of the patients had identifiable emergency department outcomes. More importantly, the researchers did not have any prior knowledge of any medications the patients had taken before their arrival at the emergency departments, affecting validity of the study.
Fishe, J. N., Palmer, E., Finlay, E., Smotherman, C., Gautam, S., Hendry, P., & Hendeles, L.
(2019). A statewide study of the epidemiology of emergency medical services’ management of pediatric asthma. Pediatric Emergency Care. doi: 10.1097/PEC.0000000000001743
Fishe et al. (2019b) argued that at least ten percent of all pediatric emergency department patients use emergency medical services for transport and prehospital management. While studies show that the most frequently used medication was albuterol, there is a paucity of research evidence on pediatric emergency medical services experiences with respiratory distress or asthma. Therefore, the researchers set out to investigate the relevant clinical, geographic, demographic and characteristics of pediatric asthma treated in the emergency medical services in a state with the fourth-largest pediatric population to examine the current emergency medical services treatment practices.
The retrospective observational cohort study relied on patients whose records remained in Florida’s EMS Tracking and Reporting System with information on emergency department’s outcome of patients between 2011 – 2016. The inclusion criteria were children of age 2-18 admitted in the emergency department with respiratory distress, whose acute asthma exacerbation was indicated by their receipt of albuterol. The study found that in practice, IV methylprednisolone is reserved for the small percent of patients with generally more severe asthma. However, they are more liberally administered in the emergency department because they are of benefit to those with moderate and severe asthma exacerbations.
These findings are important to the study of IV methylprednisolone as a treatment therapy for pediatric asthma in the emergency department because it explores the general practice and how IV methylprednisolone is used. However, it has several methodological limitations that limits its generalizability. For instance, the study only focused on one state and this affects its generalizability to other areas of the United States. Furthermore, the EMS Tracking and Reporting System does not distinguish ground versus air transport, and therefore some emergency medical service users might have been omitted.
Leung, J. S. (2021). Paediatrics: how to manage acute asthma exacerbations. Drugs in Context,
Leung (2020) considers asthmas one of the most common chronic illnesses in children and a major contributor of child death globally. As such, the researcher conducted a review of literature to investigate the various medications used in treating acute asthma exacerbations and their efficacy. The review presented the evidence in the context of a stepwise management of acute asthma exacerbations and provided several recommendations for practice based on his findings.
The study found that in children, IV methylprednisolone is a recommended oral medication that may however be safe due to concerns associated with vomiting. Furthermore, Leung (2020) observed that there is a paucity of data supporting that IV methylprednisolone can provide additional efficacy benefits over other oral formulas. Furthermore, the study did not find any evidence of increased intramuscular corticosteroids have better benefits that oral corticosteroids.
The findings of this study are useful in having a better understanding of IV methylprednisolone as a corticosteroid used to treat acute asthma exacerbations. It compares IV methylprednisolone with other therapies to give a better comparison of evidence on the treatment of acute asthma exacerbations in children. However, because the study relied on secondary data, the generalizability of study is affected by the literature search and selection bias.
Batabyal, R. A., & O’Connell, K. (2018). Improving Management of Severe Asthma: BiPAP and
Beyond. Clinical Pediatric Emergency Medicine, 19(1), 69-75. https://doi.org/10.1016/j.cpem.2018.02.007
Pediatric emergency departments encounter unique challenges with acute asthma exacerbations. Whereas most children respond well to treatments such as systemic corticosteroids, ipratropium, and inhaled ?2-agonists, some children may require adjunct treatments. As such, Batabyal and O’Connell (2018) conducted a literature review study to investigate the various guidelines on the management of severe asthma exacerbations in pediatric emergency departments.
The review covers both the use of heliox as well as the use of Corticosteroids such as IV methylprednisolone. Reviewed evidence indicate that early use of IV methylprednisolone is important and even a slight delay can increase the chances of hospital admission. Another important finding of this review is that whereas one would want to administer more doses of IV methylprednisolone to mitigate inflammation, there is no evidence supporting greater doses of more than 2mg/kg even in the case of acute asthma; and therefore, higher doses is not recommended.
On heliox, the study revealed variable efficacy of heliox as a therapy for acute severe asthma exacerbations among the Pediatric population. However, the reviewed evidence also shows that some guidelines (e.g. NAEPP) recommend the administration of inhaled beta agonists with heliox in patients whose asthma exacerbations is life threatening. Similarly, as per Batabyal and O’Connell (2018), the GINA guidelines recommend heliox for acute severe asthma for patients who do not respond to conventional treatment.
Practice guidelines are integral part of evidence-based practice because they reveal the generally accepted practices backed by evidence. As such, the study by Batabyal and O’Connell (2018) is useful in studying the use of IV methylprednisolone and or heliox in the management of acute severe asthma in children because it compares various guidelines on the same. However, the study is limited by the fact that it relies on secondary material, which is susceptible to selection and inclusion bias.
Indinnimeo, L., Chiappini, E., & Del Giudice, M. M. (2018). Guideline on management of the
acute asthma attack in children by Italian Society of Pediatrics. Italian Journal of Pediatrics, 44(1), 1-10. https://doi.org/10.1186/s13052-018-0481-1
Indinnimeo et al. (2018) opined that it is important to deliver appropriate care to children with asthma considering its life-threatening risk and its high prevalence on children. In the spirit of evidence-based practice, they conducted a study to guide the management of asthma attack in children. The study relied on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. They also conducted a literature search on Cochrane library to retrieve Italian journal articles on children of age 2 years and above.
One of the most relevant recommendation given by Indinnimeo et al. (2018) is that heloix can be given to children with life-threatening asthma attack, especially for those not responding to alternative treatment. The study further explained that heloix can improve ventilation and reduce respiratory failure in patients experiencing airway obstruction. This study gives important insights that are useful in answering some of the background questions of the study such as those concerning the therapeutic options of severe asthma.
Seliem, W., & Sultan, A. M. (2018). Heliox delivered by high flow nasal cannula improves
oxygenation in infants with respiratory syncytial virus acute bronchiolitis?. Jornal de Pediatria, 94, 56-61. https://doi.org/10.1016/j.jped.2017.04.004
The study by Seliem & Sultan (2018) evaluates how heliox delivered through high flow nasal canula can improve oxygenation in children with respiratory syncytial virus acute bronchitis/asthma. It took the design of a randomized control trial that included 48 patients. The treatment group received heliox (70:30) while the control group received air-oxygen mixture through high flow nasal cannula at 8 L per minute continuously for 24 hours. After two hours of treatment with heliox, the treatment group registered a more significant improvement compared to the control group of 98.3% versus 92.9% respectively.
Seliem & Sultan (2017) concluded that transient improvement of oxygenation can be achieved in children with respiratory syncytial virus acute bronchitis if heliox is used so that other therapeutic agents can find more time to work on the disease and resolve it naturally. However, this study has a few limitations. First, the randomization was not blinded due to an existing discrepancy between the delivery systems of both gases. Furthermore, the small sample size hindered discrimination between clinical phenotypes based on chest radiology.
Hello Olugemo, I have gone through your post on ankle pain concerning your case study of F. F., a 46-year-old female who presented with bilateral ankle pains and here are responses. You explored the ankle pain very well in your history but don’t you think knowing if the pain is radiating, its relieving factors and the timing (if it is constant or intermittent) would have been an important part of your pain history. Still in your history it would be of significance to rule out history of complicating conditions of ankle injury such as diabetes, arthritis and connective tissue disorders.
Your evaluation of the patient in terms of physical assessment was well done as it confirmed that the right ankle was severely injured compared to the left. The presence of ecchymosis and a higher pain grading scale on the right all support this. The ankle is prone to injury because of its complexity. The injuries range from ankle ligament injuries to fractures to fracture subluxation and dislocation. Grade I and II ankle injuries cause stretching or microscopic tears of the stabilizing ligaments while Grade III ankle sprain may interfere with syndesmotic structures. Moreover, the highest energy incidents may disrupt the tendons and cause fractures. With ankle sprain the most commonly involved structure is anterior talofibular ligament and or calcaneofibular ligament (Melanson & Shuman, 2020).
Information about the diagnostic tests such as the need for X-ray and specific evaluations for ankle injury were well captured. In addition, it would have been necessary to do a Kleiger test to rule out injury to the deltoid ligament (Larkins, Baker & Baker J., 2020) and inversion stress maneuver to assess the integrity of calcaneofibular ligament. Am also in agreement with your assessment differential diagnosis as F.F is likely to have bilateral lateral ankle sprains based on her presentation, Further, it appears that her ankles were forcefully rolled out of their normal position during the exercise, hence stretching them. Generally, your diagnostic formulation was fine all the way from history to differential diagnosis. Thank you.