4k25 research 2

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How effective is CT Colonography in detecting colon cancer?

Introduction

 

The second cause leading to death in the United States is colorectal cancer in the same way colorectal cancer is the third common cancer in women and men. In the United States 135,260 people diagnosed with colorectal cancer in 2011. Colorectal cancer caused for 51,783 people from them the death. The number of colorectal cancer patients is predictable to rise in the future. Built on the present data, cost scenario and survival for colorectal cancer Yabroff et al expected the cost effect in 2020 for the primary $4.05 billion, making a significant cost load on the healthcare system. Colorectal cancer mortality was decreased by 18% to13 % with apply CT Colonography to detect colonic polyps before they developed to colorectal cancer (Trilisky et al, 2015). CT Colonography has been shown to have polyp discovery rates similar to the patient how use colonoscopy. CT Colonography is an exam for colorectal cancer screening which became generally effected for detecting polyps similar to those of colonoscopy. It has the prospective to improve colorectal cancer screening rates because of colorectal is come to be insignificant noninvasive ,faster patient in quantity ,no sedation requirement and potential for reduced cathartic examination . Appropriate program of a CT Colonography screening must implement and needs important announce to several aspects, counting proper patient preparation before the investigation, image acquisition, and post-processing of the developed images. A CT Colonography need workstation with special software and high quality monitors. Special software called Computer-Aided Detection CAD which is manipulate to reduce mistakes of spotting and showing polyps to the radiologist for images interpretation. These essay will discuss technique, advantages , disadvantages of CT Colonography and how CT Colonography can be affect for colorectal cancer .

 

 

Exam technique

 

Currently, patients go through intestine preparation procedure which has the purpose of avoid misdiagnosed of polyps by cleaning the colon. So far there is no agreement on a best program of food adjustment and releasing preparation of flexible period and amount. There is continuing studies aimed to rise patient relaxation and acceptance. To distinguish polyps from other residual the use usually fecal and fluid tagging with bowel laxative. Some time they do it with small quantity of both iodine-based contrast material and barium or one of them to improve the image and to eliminate the artifact of image which could be accrue ,which may rise the sensitivity of polyp detection, Digital subtraction is a post-acquisition processing technique use to improve the image quality(Trilisky,2015).

 

Advantages of CT Colonography

 

CT Colonography shows high sensitivity and specificity of detecting cancer lesions than colonoscopy. According to Perry Pickhardt(2015) the sensitivity of CT Colonography to detect lesion showed after a meta-analysis and systematic revision an overall 96% and it is coming higher if oral contrast is applied. This ratio give CT Colonography opportunity to use it for preventive and screening more than colonoscopy. In addition, colonoscopy y is invasive exam which might harmful the patients. However, this high percentage of detecting legion is my decay with lesions less than 6mm. Andrik, Aschoff (2007),fond after reviewing many studies don from 2000 until 2005 the specificity and sensitivity of catching of colon cancer is high with 10mm or more in size of polyps .He estimate that CT Colonography could increase sensitivity in this coming years and this is what happened now it is increase up to 6 mm for detection of polyps.

 

Bleeding, colonic perforation, cardiovascular events and even death are complication with low percent of colonoscopy exams while almost zero percent in CT Colonography when automated low – pressure CO2 is used. Igor Trilisky, is radiologist in University of Chicago Medical Center, recommended to establish CT Colonography screening program for colon cancer on condition of implementing a quality assurance in the center. Proper patient preparation and image acquisition help the radiologist to read the image correctly. High quality training of radiologist and technologist is potential to good image interpretation. In particular, time of CTC exam is short in procedure but it take time to processing the image and read it mort ah Colonoscopy. In addition, using updated CAD help to improve sensitivity in image interpretation CT Colonography exams and decrease the specificity.

 

 

All of the aforementioned reasons to prefer CT Colonography form most patients especially how had colonoscopy before or both and if we look to Self-appreciation we found it is one of the most reason push the patents to choose CT Colonography as first option. Based on Pickhardt(2015) multicenter surveying 1400 adult how had CTC before founded high satisfaction percentage almost higher than 90% and same percent preferred to choose CT Colonography again for second screening. Researcher found highly ratio of chosen CT Colonography than colonoscopy for patent how had CT Colonography and colonoscopy before with nearly 6:1 ratio. Pickhardt(2015) found same thing happened with Moawad et al. They found that 95% of patients how had both experience of exams preferred CT Colonography screening.

 

 

 

 

Disadvantages of CT Colonography

 

Radiation exposure is the most concern issue in CT exams in general because there is no threshold of ionization radiation. In the same time too high exposure have same value of very low exposure dose for radiologist it means no data can be collected from image. J. Stoker, H. W. Venema, and R. E. van Gelder fond in tow studies ,don in 2004, low dose technique 120Kv and 10mAs (in supine position only )with series patient preparation held on 137 patient sensitivity and specify 70% and 80.8% respectively for polyps more than 4 mm. The other study were done in same year for 203 patients with 140Kv and 10mAs ( tow position) result in 95% in sensitivity and 92.2% in specify for polyps more than 7mm and 100% for both for polyps more than9mm. The average effective doses in first study was 0.7ms for men and 1.2 ms for women and 1.8 ms for men and average effective dose 2.4ms for women in second study (Tack, Gevenois,2007). Nowadays, we have inflation of the technology of post processing data which will may increase the sensitivity and specificity of detecting polyps and as the technology progressed as the ability of diagnose the polyps in early stage. So radiation can cause cancer itself which incumbent us to adequate using of exam.

 

CTC has the ability to detected most of polyps which might be developed to colorectal cancer. On the other hand, it may missed detection happened with small polyps less than 5mm. Generally 90 % of polyps are detected by CTC. 3.36. Based on Pickhardt(2015) experience, radiologist in University of Wisconsin School of Medicine and Public Health, 50% from small polyps are stable, 30 % regress and 20% remaining developed under observation. Instead of this, CT Colonography is extra colonic exam as well, it can evaluate the entire organ (abdomen and pelvis) also it has opportunity to evaluate osteoporosis without need to extra radiation dose. In fact, CT Colonography has high chance to be the first screening exam for colorectal cancer.

 

 

Experience of CTC observers

 

CT Colonography is observer dependent make image reading defer from center to other. A cumulative experience of reading CT Colonography is helpful to increase sensitivity and specificity as the English Bowel Cancer Screening Program find high positive rate in centers with experience of interpretation of 1000 case or more and centers which have at least 175 study for radiologist yearly. This outcome of Dutch study held on six radiologist and three CT technologist. They had training program of CT Colonography image interpretation. It shows significant increasing of average sensitivity of detecting polyps 6mm or more for 50 case from 76% in first set to 91% in fourth set. They recommend 164 case for training for each radiologist to increase his ability of interpretation (Haan, 2014).

 

In conclusion, CT Colonography has prospect to be good option of colorectal cancer screening considering a proper patent preparation, high quality training for both radiologist and CT technologist, highly cooperation from patients and updated CAD soft were. CT scan device has an inflation of soft were and hard were in this recent year make the sensitivity of detecting polyps increase rabidly with almost zero percent of complication. In terms of this advantages medical practitioners have to trust the exam and generalize it to help patients to survive from colorectal disease.

 

 

Index:

 

· CAD : Computer-Aided Detection special software called CAD which is manipulate to reduce mistakes of spotting and showing polyps to the radiologist for images interpretation.

· CRC : colorectal colon cancer colorectal adenoma is a benign glandular tumor of the colon and the rectum.

· CT computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional images.

· Contrast media: is a substance used to enhance the contrast of structures or fluids within the body in medical imaging.

· CTC : computer tomography for colon.

· Ionization radiation: is radiation that carries enough energy to free electrons from atoms or molecules.

· Kv: The strong of power penetration

· ms : The amount of electromagnetic radiation.

· Polyps : small clump of cells that forms on the lining of the colon. Most colon polyps are harmless. But over time, some colon polyps can develop into colon cancer, which is often fatal when found in its later stages

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Assessment 4 Final Care Coordination Plan

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PICO(T) Question

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Special Considerations for Patient Populations

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leadership self-assessment

General instructions:

Complete this assignment following the steps below.

1. Address the requirements above. Use the leadership self-assessment template (see attachment ). Submit as a .doc or .docx file with your name included in the file name.

2. Write 2-4 total pages (excluding title and reference pages). At least 4 references including one scholarly article.

3. Correctly cite and reference ideas and information that come from scholarly sources of information using APA current edition.

4. Follow rules for grammar, spelling, word usage, and punctuation consistent with formal, scholarly writing.

Reflect on your leadership experience, philosophy, and self-leadership skills and include the following sections (detailed criteria listed below and in the grading rubric):

  1. Introduction      (6%)
  2. Personal      Leadership Experience (17%) 
  3. Leadership      Style (17%).
  4. Leadership      Competencies(20%)
  5. Strategies      (23%) 3 strategies and one scholarly source for each strategy.
  6. Conclusion      (6%)

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WK 5 Ass 2

Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals

 

Synthesis and Recommendations Tool

Appendix H

 

 

 

 

 

EBP Question:

 

Strength Number of Sources (Quantity) Synthesized Findings With Article Number(s)

(This is not a simple restating of information from each individual evidence summary—see directions)

Level Overall Quality Rating

(Strong, good, or low)

   
Level I

· Experimental studies

     
Level II

· Quasi-experimental studies

 

 

 

 

 

 

 

 

   
Level III

· Nonexperimental, including qualitative studies

 

 

     
Level IV

· Clinical practice guidelines or consensus panels

 

 

 

 

 

 

   
Level V

· Literature reviews, QI, case reports, expert opinion

 

 

 

 

 

 

 

   

 

 

 

 

 

Where does the evidence show consistency?
 
Where does the evidence show inconsistency?
 

 

Best evidence recommendations (taking into consideration the quantity, consistency, and strength of the evidence):
 

 

 

Based on your synthesis, select the statement that best describes the overall characteristics of the body of evidence.
☐ Strong & compelling evidence, consistent results Recommendations are reliable; evaluate for organizational translation.

☐ Good evidence & consistent results Recommendations may be reliable; evaluate for risk and organizational translation.

☐ Good evidence but conflicting results Unable to establish best practice based on current evidence; evaluate risk, consider further investigation for new evidence, develop a research study, or discontinue the project.

☐ Little or no evidence Unable to establish best practice based on current evidence; consider further investigation for new evidence, develop a research study, or discontinue the project.

 

 

 

 

 

 

 

 

 

See Chapter 11, Lessons from Practice, for examples of completed tools.

 

Directions for use of the Synthesis and Recommendations Tool

Purpose:

This tool guides the EBP team through the process of synthesizing the pertinent findings from the Individual Evidence Summary (Appendix G), sorted by evidence level, to create an overall picture of the body of the evidence related to the PICO question. The synthesis process uses quantity, strength (level and quality), and consistency to generate the best evidence recommendations for potential translation.

Overall quality rating and the total number of sources:

Record the overall quality rating and the number of sources for each level (strong, good, or low), ensuring agreement among the team members.

Synthesized findings:

This section captures key findings that answer the EBP question. Using the questions below, generate a comprehensive synthesis by combining the different pieces of evidence in the form of succinct statements that enhance the team’s knowledge and generate new insights, perspectives, and understandings into a greater whole. The following questions can help guide the team’s discussion of the evidence:

· How can the evidence in each of the levels be organized to produce a more comprehensive understanding of the big picture?

· What themes do you notice?

· What elements of the intervention/setting/sample seem to influence the outcome?

· What are the important takeaways?

Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool. Record the article number(s) used to generate each synthesis statement to make the source of findings easy to identify.

Using this synthesis tool requires not only the critical thinking of the whole team but also group discussion and consensus building. The team reviews the individual evidence summary of high- and good-quality articles, uses subjective and objective reasoning to look for salient themes, and evaluates information to create higher-level insights. They include and consider the strength and consistency of findings in their evaluation.

Where does the evidence show consistency/inconsistency?

EBP teams must consider how consistent the results are across studies. Do the studies tend to show the same conclusions, or are there differences? The synthesized evidence is much more compelling when most studies have the same general results or point in the same general direction. The synthesized evidence is less compelling when the results from half the studies have one indication, while the findings from the other half point in a different direction. The team should identify the points of consistency among the evidence as well as areas where the inconsistency is apparent. Both factors are important to consider when developing recommendations or determining the next steps.

 

Best evidence recommendations:

In this section, the EBP team takes into consideration all the above information related to the strength, quantity, and consistency of the synthesized findings at each level to generate best practice recommendations from the evidence. Consider:

· What is the strength and quantity of studies related to a specific evidence recommendation?

· Is there a sufficient number of high-strength studies to support one recommendation over another?

· Are there any recommendations that can be ruled out based on the strength and quantity of the evidence?

· Does the team feel the evidence is of sufficient strength and quantity to be considered a best evidence recommendation?

Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP question. The team bases these recommendations on the evidence and does not yet consider their specific setting. Translating the recommendations into action steps within the team’s organization occurs in the next step (Translation and Action Planning Tool, Appendix I).

Based on the synthesis, which statement represents the overall body of the evidence?

Choose the statement that best reflects the strength and congruence of the findings. This determination will help the team to decide the next steps in the translation process .

When evidence is strong (includes multiple high-quality studies of Level I and Level II evidence), compelling, and consistent, EBP teams can have greater confidence in best practice recommendations and should begin organizational translation

When most of the evidence is good (high-quality Level II and Level III) and consistent or good but conflicting, the team should proceed cautiously in making practice changes. In this instance, translation typically includes evaluating risk and careful consideration for organizational translation.

The team makes practice changes primarily when evidence exists that is of high to good strength. Never make practice changes on little to no evidence (low-quality evidence at any level or Level IV or Level V evidence alone). Nonetheless, teams have a variety of options for actions that include but are not limited to, creating awareness campaigns, conducting informational and educational updates, monitoring evidence sources for new information, and designing research studies.

The exact quantity of sources needed to determine the strength of the evidence is subjective and depends on many factors, including the topic and the amount of available literature. The EBP team should discuss what they consider sufficient given their knowledge of the problem, literature, and setting

 

 

 

 

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Benchmark – Policy Brief Infographic

The purpose of this assignment is for students to create an infographic to educate the community on the impact of a public health issue and make recommendations for policy change.

Research public health issues located on the American Public Health Association (APHA) website, found in the topic Resources under “Topics and Issues.” Select a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Based on the public health issue selected, create an infographic that briefly addresses the following:

  • Describe the selected public health issue and its impact on the community. Include data that demonstrate the significance of this issue and key risk factors leading to this issue.
  • Discuss ways that the public health issue can be prevented, including key concepts of epidemiology.
  • Explain a policy that currently addresses this issue and the impact of this policy on population outcomes including social justice and health equity.
  • Propose at least one change to existing policies to better address this issue. Support recommendations with appropriate evidence.
  • Summarize what steps are required to initiate policy change. Identify necessary stakeholders required to initiate policy change (government officials, administrator, etc.) and explain their level of influence.

Refer to the resource “Images, Infographics and Graphics Resources,” located in the GCU Library, for additional guidance on completing this assignment in the appropriate style.

Cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

3.4: Advance equitable population health policy.

3.5: Demonstrate advocacy strategies.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 3.4 and 3.5

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Transitioning From Closed to Open Systems

How do effective nurse leaders and others approach problem solving and decision making in organizations? As suggested in this week’s Learning Resources, systems theory provides a valuable way to assess situations and prepare to address problems.

 

For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.

 

Note: You may find it helpful to view the Assignment instructions and use the same problem for this Discussion.

 

To prepare:

 

  • Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems.
  • Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved.
  • Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes?

 

Post (1) a description of the problem that you identified in your selected organization. (2) Explain the problem from a closed-system perspective. Then, (3) describe how the problem could be addressed by viewing it from an open-system perspective, and (4) explain how this modification would help you and others improve health care outcomes.

 

 

 

Required Resources

 

.

 

Readings

 

  • Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
    • Review Chapter 7, “Strategic and Operational Planning”

      See especially Figure 7.1 on page 147.

    • Chapter 8, “Planned Change”
      • Organizational Change Associated With Nonlinear Dynamics (pp. 172–176)

        Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.

    • Chapter 12, “Organizational Structure”
      • “Organizational Culture” (pp. 274–276)

        There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.

  • Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

    This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.

  • Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4 (1) [2].

    Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.

  • Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
    Retrieved from the Walden Library databases.

    In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

 

Optional Resources

 

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NRNP 6552 Kita Brown 36 year-old G1Po

 . Case Study: Hypertension in Pregnancy
Kita Brown is a 36-year-old G1 P0 black female presenting to her local urgent care with
headache and stating her mother took her blood pressure and it was a “little higher than it
should be”. Kita has had an unremarkable pregnancy, which was conceived thru IVF. She is
currently 30 5/7 weeks pregnant and relates she has had no problem with her pregnancy. She
only takes prenatal vitamins, and relates she was on hctz prior to pregnancy for borderline BP
but stopped it when she underwent IVF and her BP has remained “pretty normal”. Sher relates
she was prescribed po labetalol but did not take it regularly as she didn’t want to take anything
that might hurt the baby.
Her initial prenatal screening, including initial labs, and third trimester CBC and glucose testing
have been normal. She additionally at her 1st prenatal visit had baseline PIH (pregnancy
induced hypertension/pre-eclampsia) due to her history of hypertension which were normal
including a protein to creatine ratio.
Upon intake at the urgent care the notes relate she appears in no apparent distress, and she
has reported fetal movement within the past hour. She denies, any other symptoms including
epigastric pain, vision changes or nausea. She states fetal movement has been normal, and
denies leaking fluid, vaginal bleeding, or contractions. She relates slight swelling and her weight
gain date has been 17 lbs. Current BMI is 25.1. BP is 162/90, pulse 82, respirations 16 and
unlabored, temperature 98.2 orally. Kita was transferred to the emergency room due to her
complaints and her gestational age.
Upon arrival to the emergency room 30 minutes later her repeat BP was 166/ 88. It was retaken
15 minutes later and was 162/92. All blood pressures were confirmed with a manual cuff. She
had no additional complaints.

 

Based on your assigned case study, post a Focused SOAP NOTE with the following:

  • Differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.
  • Define what you believe is the most important diagnosis. Be sure to include the first priority in conducting your assessment.
  • Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.

Your differential diagnosis, what you believe the most important diagnosis is and why, additional diagnostic tests and treatments and rationales are what this assignment and grading is focused on.

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