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Please read the 4 student posts attached, select any 2 post and respond individually in not more than one page for each post. cite at least 2 references for each post. References should be no more than 5 years old.

Please read the 3 discussion board posts attached, select 2 out of the 3 and respond individually in one page for each post. All references used should be no more than 5 years old. You could point out the similarities or differences in the laws governing schedule II and III drugs in Illinois as compared to the other students state, thank you.

no cover page necessary. The assignment does not have to be 4 pages long. if you can answer the questions in less than 4 pages, that’s ok, thanks.

Note to writer: Please read the 2 student posts below, pick one and respond in one page with references not more than 5 years old. Use apa 7th edition (agree, disagree or both, or highlight points the student already made). This is due to be submitted on Sunday 10:59PM central American time after which it will be locked. Thank you for being very time sensitive.

 

1)     Mary J’s Post

1. By now you should realize that research is ongoing and there is often new or more information available.  We realize you developed a PICOT question in MSN 600 and did part of this assignment.  Now it is time to take it to another step and look at your subject deeper.  If you liked your question, you may use it again here.  It is now time to improve your question, do so now.  If you do not like your question, start afresh.  Researchers typically modify their research question many times before they finalize it.  Choose a problem or issue that you anticipate within your future advanced nursing role.  Describe this problem in 5 sentences or less.  You will be able to use it in the next assignment and in future courses.

One problem I anticipate encountering within my future APRN role is treatment resistant major depression. I plan to become a Psychiatric Mental Health Nurse Practitioner (PMHNP). Many patients do not respond to pharmacologic, electroconvulsive therapy (ECT), or cognitive behavioral therapy (CBT) treatments for Major Depressive Disorder (MDD). These patients are categorized as treatment resistant (Nazar, 2020). This diagnosis a leading cause of disability in the United States (Nazar, 2020).

1.  
2. Formulate your question using the PICOT format.  For those of you in clinical concentrations (NPs), your question needs to be a clinical question.  The NEL and NED students may develop a question within their concentration’s focus. This question will drive the literature search for your issue.   

 

In patients with treatment resistant depression, does Transcranial Magnetic Simulation (TMS) provide a safe, effective alternative in comparison to pharmacologic treatment, ECT, and CBT over 12 weeks’ time?

P- patients with treatment resistant depression; not responding to pharmacologic treatments, ECT, or CBT.

I-Transcranial Magnetic Stimulation (TMS)

C- pharmacological treatment with antidepressants, ECT, CBT

O- safe and effective treatment of depression

T- 12 weeks

1.  
2. To support and assist in choosing and writing your PICOT in question 1 of this discussion board, you should have reviewed a minimum of 6-10 articles with at least one being a quantitative design.  List the 6-10 articles here as a response to this #3 question.  The articles should be in alphabetical order and each article should be listed as a full citation using the APA format.
3.  
4. Grimley Baker, K. (2020). Treating depression with transcranial magnetic stimulation. Nursing 2020, 50(5), 18-20. file:///Users/maryellenjohnson/Downloads/Treating%20depression%20in%20adults%20with%20transcranial%20magnetic%20stimulation.pdf
5.  
6. Kaster, T.S., Daskalakis, Z.J., Knyahnytska, N.Y., Downar, J., Rajji, T.K., Levkovitz, Y., Zangen, A., Butters, M.A., Mulsant, B.H., & Blumberger, D.M. (2018). Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: A prospective randomized control trial. doi: 10.1038/s41386-018-0121-x
7.  
8. Levkovitz, Y., Isserles, M., Padberg, F., Lisanby, S.H., Bystritsky, A., Xia, G., Tendler, A., Daskalakis, Z.J., Winston, J.L., Dannon, P., Hafez, H.M., Reti, I.M., Morales, O.G., Schlaepfer, T.E., Hollander, E., Berman, J.A., Husain, M.M., Sofer, U., Stein, A., Adler, S., Deutsch, L., Deutsch, F., Roth, Y., George, M.S., Zangen, A. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: A prospective multicenter randomized controlled trial. World Psychiatry, 14, 64-73. 
9.  
10. Narang, P., Madigan, K., Sarai, S., & Lippman, S. (2019). Is transcranial magnetic stimulation appropriate for treating adolescents with depression? Innovations in Clinical Neuroscience, 16(9-10), 33-35. 
11.  
12. Nazar, S. (2020). Transcranial magnetic stimulation for treatment resistant depression. Nursing Made Incredibly Easy. file:///Users/maryellenjohnson/Downloads/Transcranial%20magnetic%20stimulation%20for%20treatment-resistant%20depression.pdf
13.  
14. Rosenberg, O., Zangen, A., Stryjer, R., Kotler, M., & Pinhas, N.D. (2010). Response to deep TMS in depressive patients with previous electroconvulsive treatment. Elzevier Journal: Brain Stimulation, 3(4), 211-217. 
15.  
16. Senova, S., Cotovio, G., Pascual-Leone, A., Oliveira-Maia, A.J. (2018). Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis. Elsevier Journal: Brain Stimulation, 119-128. 
17.  
18. Silverstein, W.K., Noda, Y., Barr, M.S., Vila-Rodriguez, F., Rajji, T.K., Fitzgerald, P.B., Downar, J., Mulsant, B.H., Vigod, S., Daskalakis, Z.L., & Blumberger, D.M. (2015). Neurobiological predictors of response to dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation in depression: A systematic review. Depression and Anxiety, 32, 871-891. doi: 10.1002/da.22424
19.  
20. Choose one of those articles cited in #3 above that is a quantitativearticle and use Polit and Beck (2020), Box 4.3 – Guidelines for Critically Appraising Research Problems, Research Questions, and Hypotheses on page 65.   Answer each of the 8 questions and discuss the relationship of this article to your PICOT.

    

 The article “Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized control trial” by Levkovitz et al. (2015) employs a quantitative design. It relates to my PICOT clinical question by providing evidence transcranial magnetic stimulation (TMS) can provide a safe, effective treatment for patients who do not respond to other treatments (Levkovitz et al, 2015). This is a multicenter, double-blind randomized control trial involving 212 MDD outpatients aged 22-68 (Levkovitz et al., 2015). All of the participants “had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode” (Levkovitz et al., 2015, p. 64).

 

1. What is the research problem? Is the problem statement easy to locate and is it clearly stated ? Does the problem statement build a cogent and persuasive argument for the new study?

   

  Approximately 20-40% of patients with MDD do not respond to pharmacological or psychotherapy treatments (Levkovits et al., 2015). The lack of effective treatment for so many patients lead researchers to examine TMS as an option (Levkovits et al., 2015). The problem statement is clearly asserted within the first few lines of the study. It builds a convincing argument in favor of TMS as a treatment option.

1.  
2. Does the problem have significance for nursing?How might the research contribute to nursing practice, administration, education, or policy? 

     The problem has significance for nursing, particularly psychiatric nursing. Nurses and nurse practitioners contemplating options for patients with treatment resistant MDD should consider TMS. There is significant research supporting the use of TMS in nursing practice. This material can be used in nursing education,  and to develop policies in psychiatric nursing practices.

1.  
2. Is there a good fit between the research problem and the paradigm in which the research was conducted?Is there a good fit between the problem and the qualitative research tradition (if applicable)? 

    

 There is a good fit between the research problem and the paradigm in which the research was conducted.  The randomized, double-blind control trial comprised two groups. One group received deep magnetic stimulation, while the other received a sham treatment. The research paradigm fits the methodologic type. Quantitative and qualitative data was derived from the testing.

1.  
2. Does the report formally present a statement of purpose, research question, or hypothesis?Is this information clearly communicated and concisely, and is it placed in a logical and useful location?

     

The report clearly and concisely states its purpose in the first section. It is found at the beginning of the report, a logical location.

1.  
2. Are purpose statements or questions worded appropriately?For example, are key concepts/variables identified, and is the population of interest specified? Are verbs used appropriately to suggest the nature of the inquiry and/or research tradition?

     

Key concepts and variables are identified. The population of interest is specified as patients with a DSM-IV diagnosis of MDD, single or recurrent episode (Levkovitz et al., 2015). The patient must have failed at least one, but no more than four antidepressant treatments (Levkovitz et al., 2015). Patients could also have intolerance to at least two antidepressants during the current episode (Levkovitz et al., 2015). Verbs are properly used to describe the problem, and methods to improve it.

1.  
2. If hypothesis were not formally stated, is their absence justified?Are statistical steps used in analyzing the data despite missing hypothesis? 

    

 The hypothesis is formally stated. TMS is proposed for treatment resistant MDD (Levkovitz et al., 2015). Numerical data is also included in results.

1.  
2. Do hypotheses (if any) flow from a theory or previous research?Is there a justifiable basis for the predictions? 

     

Levkovitz et al. (2015) note TMS has previously been researched in diagnoses such as schizophrenia and bipolar disorder. These studies provide evidence of improvement in depression when magnetic stimulation was performed over the left dorsal lateral prefrontal cortex (Levkovitz et al., 2015). This research provides an empirical basis to predict TMS would improve treatment resistant MDD.

1.  
2. Are hypothesis (if any) properly worded- do they state a predicted relationship between two or more variables? Are they directional or nondirectional, and is there rationale for how they were stated? Are they presented as research or null hypothesis? 

     

The hypothesis TMS improves depression in patients with treatment resistant MDD is supported by variables. The authors believe deep magnetic stimulation may reach areas that cause an antidepressant response lasting up to 12 weeks (Levkovitz et al., 2015). The hypothesis appears directional. It specifically describes the relationship between variables (Polit & Beck, 2017). Given the relationship between variables, the hypothesis is presented as research (Polit & Beck, 2017).

 

References

Levkovitz, Y., Isserles, M., Padberg, F., Lisanby, S.H., Bystritsky, A., Xia, G., Tendler, A., Daskalakis, Z.J., Winston, J.L., Dannon, P., Hafez, H.M., Reti, I.M., Morales, O.G., Schlaepfer, T.E., Hollander, E., Berman, J.A., Husain, M.M., Sofer, U., Stein, A., Adler, S., Deutsch, L., Deutsch, F., Roth, Y., George, M.S., Zangen, A. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: A prospective multicenter randomized controlled trial. World Psychiatry, 14, 64-73. 

 

Polit, D.F. & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.

 

2) Kathie C’s Post

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The focus of this assignment is for you to write a PICOT using the PICOT template.  You will also identify articles that relate to your PICOT.  Further, you will have an opportunity to do a basic critique of one of the quantitative articles that is included in your identified articles. 

 

1.    By now you should realize that research is ongoing and there is often new or more information available.  We realize you developed a PICOT question in MSN 600 and did part of this assignment.  Now it is time to take it to another step and look at your subject deeper.  If you liked your question, you may use it again here.  It is now time to improve your question, do so now.  If you do not like your question, start afresh.  Researchers typically modify their research question many times before they finalize it.  Choose a problem or issue that you anticipate within your future advanced nursing role.  Describe this problem in 5 sentences or less.  You will be able to use it in the next assignment and in future courses.  It has been well documented and evidenced that prone positioning in patients with Acute Respiratory Distress Syndrome (ARDS) decreases morbidity and mortality (Vincent, 2018). However, in patients with COVID-19 who have ARDS we are presented with a novel set of circumstances. My previous PICO was “In patients with ARDS does the prone position vs. the non-prone position have an effect on morbidity and mortality”? I would like to expound on that.

 

2.    Formulate your question using the PICOT format.  For those of you in clinical concentrations (NPs), your question needs to be a clinical question.  The NEL and NED students may develop a question within their concentration’s focus. This question will drive the literature search for your issue.  [P]In COVID-19 patients that develop Acute Respiratory Distress Syndrome (ARDS) [I] How does mechanical ventilation [C] Non-invasive ventilation with prone positioning [O]affect morbidity and mortality [T] post-extubation.

 

3.    To support and assist in choosing and writing your PICOT in question 1 of this discussion board, you should have reviewed a minimum of 6-10 articles with at least one being a quantitative design.  List the 6-10 articles here as a response to this #3 question.  The articles should be in alphabetical order and each article should be listed as a full citation using the APA format.

 

References

 

Coppo, A., Bellani, G., Winterton, D., Di Pierro, M., Soria, A., Faverio, P., Cairo, M., Mori, S., Messinesi, G., Contro, E., Bonfanti, P., Benini, A., Valsecchi, M., Antolini, L., & Foti, G. (2020). Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to covid-19 (pron-covid): A prospective cohort study. The Lancet Respiratory Medicine, 8(8), 765–774. https://doi.org/10.1016/s2213-2600(20)30268-x

 

Dzieciatkowski, T., Szarpak, L., Filipiak, K. J., Jaguszewski, M., Ladny, J. R., & Smereka, J. (2020). Covid-19 challenge for modern medicine. Cardiology Journal, 27(2), 175–183. 

Lu, X., & Xu, S. (2020). Therapeutic effect of high-flow nasal cannula on severe covid-19 patients in a makeshift intensive-care unit. Medicine, 99(21), e20393. 

 

Ma, X., Liang, M., Ding, M., Liu, W., Ma, H., Zhou, X., & Ren, H. (2020). Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19) Pneumonia and Acute Respiratory Distress Syndrome (ARDS). Medical Science Monitor, 26. 

 

Navas-Blanco, J. R., & Dudaryk, R. (2020). Management of respiratory distress syndrome due to covid-19 infection. BMC Anesthesiology, 20(1). 

 

Paul, V., Patel, S., Royse, M., Odish, M., Malhotra, A., & Koenig, S. (2020). Proning in non-intubated (pini) in times of covid-19: Case series and a review. Journal of Intensive Care Medicine, 35(8), 818–824. 

Sheikh, S., & Baig, M. A. (2020). Optimising ventilator use during the covid-19 pandemic. Journal of the College of Physicians and Surgeons Pakistan, 30(1), 46–47. 

 

Sztajnbok, J., Maselli-Schoueri, J., Cunha de Resende Brasil, L., Farias de Sousa, L., Cordeiro, C., Sansão Borges, L., & Malaque, C. (2020). Prone positioning to improve oxygenation and relieve respiratory symptoms in awake, spontaneously breathing non-intubated patients with covid-19 pneumonia. Respiratory Medicine Case Reports, 30, 101096. 

 

Telias, I., Katira, B. H., & Brochard, L. (2020). Is the prone position helpful during spontaneous breathing in patients with covid-19? JAMA, 323(22), 2265. 

 

Vincent, J. (2018). The Management of ARDS: What is Really Evidence Based? American Journal of Respiratory and Critical Care Medicine., 14. 

 

Zangrillo, A., Beretta, L., Scandroglio, A. M., Monti, G., Fominskiy, E., Colombo, S., Morselli, F., & Belletti, A. (2020). Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Critical Care Resusitation. 

 

4.    Choose one of those articles cited in #3 above that is a quantitative article and use Polit and Beck (2020), Box 4.3 – Guidelines for Critically Appraising Research Problems, Research Questions, and Hypotheses on page 65. Answer each of the 8 questions and discuss the relationship of this article to your PICOT.

1.  
2. 1. What is the research problem? The research problem is “Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19”(Coppo et al., 2020, p. 1). Is the problem statement easy to locate and is it clearly stated? Yes, the problem statement is easy to locate and it is clearly stated. Does the problem statement build a cogent and persuasive argument for the new study? Yes, the authors suggest that with the success of prone positioning in awake non intubated patients with acute respiratory failure due to COVID-19 that further research with larger sample size, as well as other oxygenation requirements might illicit similar results (Coppo et al., 2020).

 

2.   Does the problem have significance for nursing? Yes, as nurses who do most of the positioning for the patients it is important to understand the significance of these results and how it benefits the patients. How might the research contribute to nursing practice, in practice it is imperative that we understand the diagnosis, care plan, underlying comorbidities and prognosis of our patients. As well as what specific measures we are taking to care for the patient and how they could adversely affect them. Administration, as administrators is it important to make sure that everything, we do for our patients is safe, effective, efficient, and fiscally responsible. Education, we need to be sure that we are teaching the most up to date information possible to the next generation of nurses. Evidence-based practice leads to better patient outcomes. or Policy needs to reflect safety measures first and foremost, but also legalities and they need to incorporate evidence-based practice as well. It is imperative that above all else we keep the patient at the center of everything that we do. Their wellbeing is why we do what we do.

1.  
2. 3. Is there a good fit between the research problem and paradigm in which the research was conducted? The method used was a prospective feasibility cohort study, it appears that this was an appropriate paradigm. Is there a good fit between the problem and the qualitative research tradition [if applicable]?It appears that the research paradigm used was a good fit as results were positive and yielded data that supported the feasibility and positive physiologic effect of prone positioning on non-intubated awake patients with  acute respiratory failure due to COVID-19(Coppo et al., 2020).

 

4.  Does the report formally present a statement of purpose, research question, and/or hypotheses? Yes, the report lists that the research question is How feasible and physiologically sound is it to prone non-intubated awake patients with acute respiratory failure due to COVID-19? Is this information communicated clearly and concisely and is it placed in a logical and useful location? Yes, this information is communicated clearly and concisely throughout the article.

 

5.  Are purpose statements or questions worded appropriately? For example, are key concepts/variables identified, and is the population of interest specified? Yes, key concepts being, prone positioning, COVID-19, non-intubated awake patients, acute respiratory failure, and population 18-75-year-old. Are verbs used appropriately to suggest the nature of the inquiry and/or the research tradition? Verbs are used appropriately.

 

6.  If hypotheses were not formally stated, is there absence justified? N/A Are statistical tests used in analyzing the data despite the absence of stated hypotheses? N/A

 

7.  Do hypotheses (if any) flow from a theory or previous research? Is there a justifiable basis for the predictions? Yes, previous studies were done on prone positioning in patients with Acute Respiratory Distress Syndrome (ARDS) who were mechanically ventilated, and those studies suggested that prone positioning decreased mortality (Coppo et al., 2020).

 

8.  Are hypotheses (if any) properly worded-do they state a predicted relationship between two or more variables? Yes, they are properly worded and state the relationship between the effects of prone positioning and non-intubated awake patients with acute respiratory failure due to COVID-19 Are they directional or nondirectional, and is there a rationale for how they were stated? It is a directional hypothesis because the authors state that prone positioning in non-intubated awake patients with acute respiratory failure due to COVID-19 will improve oxygenation and potentially reduce the need for intubation (Coppo et al., 2020). Are they presented as research or as null hypotheses? This is presented as research given as statistical information and literature from previous studies.

 

 

 

 

 

 

 

Note to writer: There are 5 students discussions here, please select 4 out of the 5 posts and comment individually in 4 separate pages ( some posts have embedded videos). Site at least 2 peer reviewed articles for each response. Articles should be no more than 5 years old. This assignment is due to be submitted Sunday @10:59pm Central American time and will be locked after that. Thank you for being very time sensitive. Also, responses can be half to one page long but no more, thanks.

 

1.     Nikki W’s post

Elevator Speech Talking Points

The elderly homebound population often have complex medical diagnosis, are on several types of medications and have underlying co-morbidities that require a thorough assessment. For a proper assessment, a telehealth visit can be a dangerous tool to take advantage of with this population.

• It also found that older adults are returning to practice settings at higher rates than other age groups, especially compared to school age children. (“Patients steadily return to in-person primary care as Telehealth plateaus,” 2020)
• Visits should be restricted to their regular provider due to the pop-up telehealth clinics can “pose a danger to patients who are taking multiple medications, as hazardous interactions could be missed” (McCauley, 2020, p.8)
• Telehealth visits can be very beneficial, save time and money. Those patients that are homebound can benefit greatly due to their inability to make it to follow up appointments, however, “barriers to use of telehealth included inadequate staff training, lack of guidelines for client referrals and integration of telehealth in nursing workflow, lack of trust in equipment’s accuracy, and certain patient characteristics” (Radhakrishnan, 2012, p.176).
• While the older population adjusts to the technology advanced society there are many downfalls to telehealth visits. Those include the technology difficulties, dexterity complications and knowledge deficits.
• There has been a growing interest in using telehealth and Internet-based healthcare among patients, those with chronic diseases, and the elderly have access difficulties, or many other sociodemographic factors. All these things should be considered when scheduling a telehealth visit. When a patient goes to an in-person office visit much of the information is often forgotten, when adding the stress of having to use technology that you are not comfortable with to that factor the patient is not going to retain much of the information being given to them.
• My concern is that the elderly population with chronic diseases and many different disease processes are not getting the proper assessment they need for the level of care they require. As of July 1, 2019 KY became a telehealth parity state meaning a telemedicine visit can be reimbursed the same way an in-person visit would. Although there are many benefits to a telehealth visit there are a few concerns that I have, one being the proper assessment of a patient.

 

References

Dana McCauley. (2020, July 3). Doctors call for rules on telehealth. The Age (Melbourne, Australia), 8.

Federal and state legal and regulatory resources. (n.d.). Kentucky TeleCare | University of Kentucky College of Medicine. 

Kentucky telemedicine: State laws and policies. (2020, September 2). eVisit. 

Patients steadily return to in-person primary care as Telehealth plateaus. (2020, May 21). Healthcare Dive. 

Radhakrishnan, K., Jacelon, C., & Roche, J. (2012). Perceptions on the use of Telehealth by Homecare nurses and patients with heart failure. Home Health Care Management & Practice, 24(4), 175-181. 

(n.d.). Welcome – Kentucky Board of Medical Licensure. 

2.     Renay M’s Post

VAPING & E-CIGARETTES REGULATIONS

The Problem: There has been an increase in the number of adolescents that are addicted to nicotine because they use electronic cigarettes also known as vaping.

• According to a recent national survey by the CDC and the U.S. Food and Drug Administration an estimated 28% of high-schoolers and 11% of middle-schoolers are current vape users (Vestal, 2020, para. 4).
• These devices “are just concentrated amounts of drugs disguised as electronic gadgets” (National Institute of Drug Abuse, 2020, para. 5).

The Concern: Recent outbreak of acute lung disease and deaths have been linked to e-cigarettes (Sindelar, 2020, para. 4).

• Vaping is dangerous because adolescents are at the stage in their life where their brains are most susceptible to permanent changes from the nicotine and addiction can begin quickly (Miech, Johnston, O’Malley, Bachman, Patrick, 2019, para. 5).
• Adolescents that have dangerous side effects must seek medical treatment which may put a strain on the hospital systems.

The Call to Action: Policies need to be put in place to control this increasing trend in adolescents (Miech, Johnston, O’Malley, Bachman, Patrick, 2019, para. 5).  

• The state government has to the power to reduce the access to e-cigarettes immensely. Ohio is one of the states that has a tax on e-cigarettes, but this is just the start.
• Adolescents are favoring the devices that have higher nicotine concentrations but cost less and they are favoring the flavored e-cigarettes. “A new analysis suggests that teens prefer mint and mango as their vaping flavors of choice for e-cigarettes” (National Institutes of Health, 2019, para. 1).
• Banning all flavors in all tobacco products can dramatically reduce the usage in our schools and homes. The state could ban flavors on vapes and e-cigarettes at essentially no cost and it could help save lives!
• The US Food & Drug Administration started a $60 million dollar prevention campaign last year which aims to reach about 10.7 million students ages 12 to 17 who are at risk (Nedelman, 2019, para. 1).
• If the information gets spread in our schools and in homes our message will be more effective and adolescents will become educated about the risks of vaping (American Heart Association, 2019, What’s working section).

At no cost to the state, Ohio adolescents do not have to be just another statistic. We can do this by empowering adolescents with the knowledge of the ingredients inside these dangerous devices along with the risks, increased taxes on devices, and banning flavors we can help put a stop to this growing epidemic!

References

American Heart Association. (2019). How to Keep Kids and Teens from Smoking and Vaping. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-to-keep-kids-and-teens-from-smoking-and-vaping

Miech, R., Johnston, L., O’Malley, P. M., Bachman, J. G., Patrick, M. E. (2019). Trends in Adolescent Vaping, 2017–2019. New England Journal of Medicine, 381(15), 1490-1491. doi:10.1056/nejmc1910739

National Institute on Drug Abuse. (2020, June 04). Vaping of marijuana on the rise among teens. https://www.drugabuse.gov/news-events/news-releases/2019/12/vaping-of-marijuana-on-the-rise-among-teens

National Institutes of Health. (2019, November 05). NIH-funded study finds teens prefer mint and mango vaping flavors. https://www.nih.gov/news-events/news-releases/nih-funded-study-finds-teens-prefer-mint-mango-vaping-flavors

Nedelman, M. (2019, July 23). What’s ‘Real Cost’ of vaping? FDA launches new campaign (watch a new ad). https://www.wraltechwire.com/2019/07/23/whats-real-cost-of-vaping-fda-launches-new-campaign-watch-a-new-ad/

Sindelar, J. L. (2020). Regulating Vaping — Policies, Possibilities, and Perils. New England Journal of Medicine, 382(20). doi:10.1056/nejmp1917065

Vestal, C. (2020). The Surprising Reasons Vaping Bans Draw Pushback. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/01/28/the-surprising-reasons-vaping-bans-draw-pushback

 

3.       Charles o’s Post

The opioid overdose is now referred to as the worst drug crisis in modern American history. This constitutes a public health emergency in which it affects the individual, the family, the community, and the entire nation. As a result of this, people die at an alarming proportion. Between the years 2016 and 2017, more than 130 daily deaths related to opioid overdose were recorded in the United States. Interestingly, heroin and opioids such as fentanyl overdose kill approximately 27,000 people a year and the trend has progressively been on the increase over the past decade. Notably, this epidemic continues to destroy lives across the nation with no regard to class, race, religion, skin color, or political affiliation. This is a serious national crisis that affects public health as well as the social and economic wellbeing of the people. According to the Center for Disease and Prevention (CDC), the economic burden associated with opioid overdose is enormous. The cost of prescription overdose amounts to approximately $78.5 billion a year. This also includes healthcare costs, criminal justice involvement, treatment of addiction, and loss of productivity (Wilson, et al, 2018).

            How does this actually happen? An opioid is a substance found in some prescribed painkillers such as morphine, oxycodone, Dilaudid, and hydrocodone. An opioid overdose occurs when someone takes an excessive amount of opioid drugs by itself or together with other drugs such as benzos, alcohol, or some other illicit drugs. As a result of this, the person involved may develop an excessive pathway for opiates which may then decrease the person’s respiratory drive and result in coma or death. Opioid overdose constitutes a medical emergency that may result in death and requires immediate life-saving measures (Adams, et al., 2020). 

            How do we know when a person is in opioid overdose? A combination of symptoms can be identified as a possible opioid overdose include lethargy, difficulty breathing, unconsciousness, and pinpoint pupils.  

            What does the government do about the opioid overdose crisis? The US Department of Health and Human Service (HHS) works to assist the states and communities as they collaborate to identify outbreaks, collect data, and provide care to those in the communities. They also maintain five major areas of priorities aimed at controlling or decreasing the incidence of an opioid overdose (Ashburn et al, 2020). They include (1) advancing better ways of pain control, (2) Promoting the use of overdose-reversing agents, (3) Providing support for research aimed at improved pain management and addiction control, (4) strengthening an understanding of the epidemic by introducing better health surveillance, (5) improving treatment,  recovery services, and creating awareness (Adams et al, 2020).

            In order to decrease the surge in opioid overdose, the CDC made recommendations on training health care providers and law enforcement on overdose prevention, identifying people with a history of and at risk for heroin and fentanyl abuse, and provide more access to naloxone, an opioid reversal agent. In addition to the efforts mentioned above, the federal government through the HHS continues to engage with the communities, faith-based organizations, addiction specialists, medical, nursing, and pharmacy personnel state and local governments, and private sector partners in order to share practices, build collaboration and identify barriers which may prevent future success (Hyo-Son You, et al, 2020).

                                                                                               

References

Adams, N., Gundlach, E., & Cheng, C.-W. (2020). An Analysis of State-Level Policies and Opioid Overdose Deaths. Western Journal of Nursing Research, 42(7), 535–542. 

Alexandridis, A. A., Doe-Simkins, M., & Scott, G. (2020). A Case for Experiential Expertise in Opioid Overdose Surveillance. American Journal of Public Health, 110(4), 505–507.

Ashburn, N. P., Ryder, C. W., Angi, R. M., Snavely, A. C., Nelson, R. D., Bozeman, W. P., McGinnis, H. D., Winslow, J. T., & Stopyra, J. P. (2020). One-Year Mortality and Associated Factors in Patients Receiving Out-of-Hospital Naloxone for Presumed Opioid Overdose. Annals of Emergency Medicine, 75(5), 559–567.

Hyo-Sun You, Jane Ha, Kang, C.-Y., Leeseul Kim, Jinah Kim, Shen, J. J., Seong-Min Park, Sung-Youn Chun, Jinwook Hwang, Takashi Yamashita, Se Won Lee, Dounis, G., Yong-Jae Lee, Dong-Hun Han, David Byun, Ji Won Yoo, Hee-Taik Kang, You, H.-S., Ha, J., & Kim, L. (2020). Regional variation in states’ naloxone accessibility laws in association with opioid overdose death rates-Observational study (STROBE compliant). Medicine, 99(22), 1–6.

Wilson N, Kariisa M, Seth P, et al. . MMWR Morb Mortal Wkly Rep 2020;69:290-297.

 

4.    Ebba T’s post

Nursing Shortage in Nevada and policy for the regulation of nursing staffing

Brain

       Due to the increased complexity of patient care and increased hospital admissions, nursing satisfaction is essential for patient care quality. According to Schultz (2016), patients became sicker than before, and they often require one to one care, which is impossible without the regulation of nursing staffing in the hospitals. More studies are now proving that proper nurse staffing decreases medical errors, incomplete shift assignments, and patients’ mortality (Walker, 2018). Furthermore, the nursing shortage leads to the enormous nurse turnover, and this is another important reason for establishing nurse staffing regulations. Job satisfaction has proven to increase job performance, productivity, and patient outcomes (Stewart & DeNisco, 2019). Although Nevada is not indicated as one of the states with the most nursing shortage, the projected most growth of registered nursing positions by 2030 is forty-one percent, which explains the urgency of nursing professionals. The American Nurses Association (2015) stated that correct nurse staffing helps increased patient satisfaction, decreased medical errors, low patient deaths, low hospital readmission, and a short length of stay. There were several bills for regulating nursing staffing to the state of Nevada being introduced, but so far, none is being accepted. Moreover, on the federal level, only one federal regulation for nursing staffing (42CFR) is being introduced to Congress, stating that the hospitals should engage in Medicare to have an appropriate number of RN’s (Mason et al., 2016).

Heart

       As a registered nurse working with medically challenged patients and behavioral issues, I have to face how the nursing shortage affects patient care daily. Most of the time, we get assigned to eight or nine patients instead of only six. These patients face many health issues, including diabetes, hypertension, congestive heart failure, respiratory failure, kidney failure, ulcers, wounds, etc. The laboratory results are continually changing and often critical. On top of their medical issues, my patients often face many secondary mental diseases. Based on the dynamic and the level of responsibility for this profession, the nursing shortage should be the last thing we should worry about. Unfortunately, it is one of the significant issues that we have to face every day, a never-ending problem that adds more stress, anxiety, and overwhelms to our job. The new law related to the nursing shortage is H. R. 2851 The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019, which is still in the first process of the legislative process. Speaking on behalf of all the nurses in Nevada, we need help from Nevada’s senators to improve policy and regulate the nursing staffing for our state.

Wallet

       Optimal nurse staffing will improve not only the quality of care and patient outcome, but also the healthcare spending. ANA’s states that nursing proper staffing has effect on prolonged hospital stay and hospital readmission (American Nurses Association, 2015). By accepting a bill or policy of regulating the nursing staffing, the state can benefit financially as it does not need to cover the repeated hospital expenses. Furthermore, a proper nurse staffing gives the nurses opportunity and more time to educate their patients on medications and medication compliance, which will decrease the unnecessary hospital readmission.

 

Reference

American Nurses Association. (2015). Optimal nurse staffing to improve quality of care and patient  

             outcomes. Retrieved from

H. R. 2581: Nurse Staffing Standards for Hospital Patient Safety and Quality care Act of 2019 (2020). 

             Govtrack. Retrieved from

             

Mason, D. J., Dickson, E. L., Perez , G. a., & McLeremore, M. R (eds.). (2016). Policy & politics in nursing and

             health care (8th ed. ). St. Louis, MO: Elsevier.

Schultz, D. (2013).  Nurses fighting state by state for minimum staffing laws.

             Kaiser Health News. Retrieved from

                

Stewart, J. G., DeNisco, S. M. (2019). Role Development for the Nurse Practitioner, (2nd. ed.). Jones & 

             Bartlett Learning. 

The States with the Largest Nursing Shortage( 2020). Registered Nursing. Retrieved from

              

Walker, A. 92018). Nursing satisfaction impacts patient outcomes, mortality. retrieved from

               

5.    Annie B’s post

 

Module 5-Elevator Speech Talking Points

Mission: Regulation on using high fructose corn syrup in manufacturing

food chains and soft drink companies to aid in healthier lifestyles.

• Talking Point 1: Eliminating high fructose corn syrup in all soft drinks,

        fast food, and manufactured food products due to its harmful effects.

Supporting argument: According to BMC Nutrition (2017), consuming

sugar sweetened beverages, leads to coronary heart disease, chronic

inflammation, insulin resistance, and impaired beta cell function. Kentucky

health facts states that obesity in Kentucky is ranked 8th in the US, with

34.3% in adults and costing the state billions in health care. A study by

Drug Invention Today (2019), shows the HFCS increase the risks of cancer,

liver disease, endocrine system, immunity, fatigue, including toxins such as

mercury in HFCS.

• Talking Point 2: Review and make changes to agriculture and

         nutritional policies for healthier food production.

Supporting argument: Siegel, et al (2016) research findings suggest “the

potential to improve the distribution of risk factors for cardio metabolic

disease and clarifying the ongoing debate about the role of agricultural

subsidies on health”. There is a need for intervention.

• Talking Point 3: Funding to farm consumers for an increase in healthier

         food production.

Supporting argument: A study by JAMA Internal Medicine (2016), states

“it costs $150-$300 billion per year for treating obesity-related

cardio metabolic diseases in the United States, which indirect, an amount

that exceeds government spending on either farm support or nutrition

assistance programs”. Applying government funding to farmers to increase

healthier food production in return, aid in a decrease in farming costs.

• Talking Point 4: Promote educational workshops for healthy eating

         specifically discussions on choosing appropriate food options.

Supporting argument: â€œSuggesting community-driven efforts may help

transform effective diet than federal policies. There are many

organizations that are involved in local and regional food systems to

ensure access to nutritious, affordable, and culturally appropriate foods to

all people” (Philpott, 2006). More recent research finding on factors

affecting healthy eating in communities includes: tight budgets, children

refusing to eat fruits and vegetables, lack of knowledge on how to cook

healthy foods, and sugar ‘addictions’, a study by Hancock et al (2019).

 

I would greatly appreciate your consideration in my proposal to better serve our communities.

My contact email is 

 

References:

DeChristopher, L. R. et al., (2017). Intake of High Fructose Corn

Syrup Sweetened Soft Drinks, Fruit Drinks and Apple Juice Is

Associated with Prevalent Coronary Heart Disease, In

U.S. Adults, Ages 45–59 y. BMC Nutrition, Vol 3(51).

doi:10.1186/s40795-017-0168-9

 

Nithya, S. et al., (2019). Potential Metabolic Effects with Use of High-

Fructose Corn Syrup in Foodstuffs: A Review. Drug Invention Today,

Vol 11(1). Retrieved from 

com.northernkentuckyuniversity.idm.oclc.org/eds/pdfviewer

/pdfviewer?vid=2&sid=40bfec0e-8bb3-4676-bcb7-

b7f88270526d%40sessionmgr101

Hackbarth, B. J., & Kerley, A. (2018). Foundation Statement: Kentucky’s

Increasing Obesity Rate Costing Billions, Threatening 1.1 Million Lives. Foundation for a Healthy Kentucky. Retrieved from ?

 

Hancock, C. et al., (2019). Supporting Individuals’ Healthy Eating Requires

Genuine Engagement with Communities. Nutrition Bulletin, Vol 44,

pp. 92–99. doi: 0.1111/nbu.12364 Retrieved from 

 

Siegel, K. R. et al., (2016). Association of Higher Consumption of Foods

Derived from Subsidized Commodities with Adverse

Cardiometabolic Risk Among US Adults. JAMA Internal Medicine,

Vol 176(8), pp. 1124-1132. doi:10.1001/jamainternmed.2016.2410.

 

Philpott, T. (2006) How the Feds Make Bad-For-You Food Cheaper than 

Healthful Fare. Grist 50:2020 Magazine. Retried from 

 

 

 

Discussion:

The focus of this assignment is for you to write a PICOT using the PICOT template.  You will also identify articles that relate to your PICOT.  Further, you will have an opportunity to do a basic critique of one of the quantitative articles that is included in your identified articles. 

1. By now you should realize that research is ongoing and there is often new or more information available.  We realize you developed a PICOT question in MSN 600 and did part of this assignment.  Now it is time to take it to another step and look at your subject deeper.  If you liked your question, you may use it again here.  It is now time to improve your question, do so now.  If you do not like your question, start afresh.  Researchers typically modify their research question many times before they finalize it.  Choose a problem or issue that you anticipate within your future advanced nursing role.  Describe this problem in 5 sentences or less.  You will be able to use it in the next assignment and in future courses.
2. Formulate your question using the PICOT format.  For those of you in clinical concentrations (NPs), your question needs to be a clinical question.  The NEL and NED students may develop a question within their concentration’s focus. This question will drive the literature search for your issue.
3. To support and assist in choosing and writing your PICOT in question 1 of this discussion board, you should have reviewed a minimum of 6-10 articles with at least one being a quantitative design.  List the 6-10 articles here as a response to this #3 question.  The articles should be in alphabetical order and each article should be listed as a full citation using the APA format.
4. Choose one of those articles cited in #3 above that is a quantitative article and use Polit and Beck (2020), Box 4.3 – Guidelines for Critically Appraising Research Problems, Research Questions, and Hypotheses on page 65.   Answer each of the 8 questions and discuss the relationship of this article to your PICOT.

Note to writer

1. please find attached PICOT article written for MSN 600. As stated in instruction number 1, feel free to use same question, modify or change it entirely but keep it related to problems a nurse practitioner or precisely, a Psychiatric Mental health nurse practitioner may encounter
2.  please cite attached book. All other sources used Must be no more than 5 years old

The focus of this assignment is for you to gain a better understanding how to analyze a quantitative research study.  This discussion board exercise introduces you to the various components of a critique and provides an opportunity for you to receive feedback prior to submitting your quantitative critique.

1. Read this fictitious study and then answer the questions that follow:

Brusser and Joansy wanted to test the effectiveness of a new relaxation/biofeedback intervention on menopausal symptoms.  They invited women who presented themselves in an outpatient clinic with complaints of severe hot flashes to participate in the study of the experimental treatment.  These 50 women were asked to record, every day for 3 weeks before the intervention, the frequency and duration of their hot flashes.  The intervention involved five 1-hour sessions over a period of 1 week.  Then for 3 weeks after the treatment the women were asked to record their hot flashes again every day.   At the end of the study, Brusser and Joansy found that both the frequency and average duration of the hot flashes had been significantly reduced in this sample of 50 women.  They concluded that their intervention was an effective therapy in treating menopausal hot flashes.   

1.  
   1. What is the independent variable in this study?
   2. What are the dependent variables in this study?
   3. Was there random assignment in this study?
   4. Is the design experimental, quasi-experimental, pre-experimental, or nonexperimental?
   5. What is the specific name of the design used in this study?
   6. Is the study design within subjects or between subjects?
   7. Was there blinding in this study?
   8. Provide at least one way in which this study could have been improved based on your chapter readings.

2. Here is a brief summary of the data collection plan of a fictitious study.  Read the summary and then respond to the questions that follow.

Traina conducted a study to investigate the relationship between adults’ blood pressure and their suppression of anger.  Data were gathered from a sample of 347 healthy men and women aged 22 to 60 who were members of a gym in Washington DC.  Subjects completed two paper and pencil scales:  The Feeling of Anger Scale and the Expression of Anger Scale.  The scales used a 9 point rating scales.  Responses to each scale were summed to yield a total score for each variable.  The subjects’ BP was measured by nurses using zero calibrated aneroid sphygmomanometers.  Weight was measured with subjects wearing only gym shorts and a t-shirt on an upright scale to the nearest 10th of a pound.  Heights was measured without shoes, feet together.  All instruments were assessed at being below the eighth grade level.  The results indicated for both men and women higher diastolic and systolic BP was associated with higher levels of suppressed anger even when various variables were statistically controlled.

1.  
   1. Which of the following types of data were collected in this study (self-report, observation, biophysiologic, records)?
   2. Were the data collection methods structured or unstructured?
   3. For which variables did Traina NOT derive numeric information?
   4. Which of the following specific methods were used (likert-type scale, semantic differential scale, event history calendar, rank-order questions, Q-sort)?
   5. Which type of data collection was used: telephone interview, personal interview, web-based interview, or self-administered questionnaire?
   6. Was readability assessed?  At what level?
   7. Provide at least one way that data collection and measurement effort be improved in this study based on your readings.

 

note to writer

please cite attached text Poilit and Beck and other sources Not more than 5 years old.