Does the research design answer the research question?  Explain your rationale.

 The research question was to assess patients with and without sepsis and determine the difference in morbidity and mortality within two years of discharge from the ICU.  Biason et al (2019) accomplished this by studying patients in the ICU through chart reviews and phone calls post-discharge.  Morbidity was evaluated through assessments of activities of daily living, pain, and readmissions.  Mortality was reviewed by the survival rate.  The results of the study showed both a higher morbidity rate and mortality rate (P<0.001) in ICU patients with a diagnosis of sepsis.  The results of the study aligned with the researcher’s hypothesis (Biason et al., 2019).

Were the study sample participants representatives? Why or why not?

            The sample participants represented the research question by being admitted to the ICU and having a diagnosis with or without sepsis.  Both genders and anyone over age eighteen was included in the study.  Patients who were discharged received follow up for two years.  Only twenty-one patients were lost in follow-ups (Biason et al., 2019).  However, a limitation not indicated by the study was a power analysis of the sample size.  This analysis would have helped determine the adequacy of the participant same size (Chamberlain College of Nursing, 2021). 

Compare and Contrast the study limitations in this study.

 The limitations of the study by Biason et al (2019), included not reviewing the cause of death in the participants, no validity of the Karnofsky and Lawton IADL scales in acutely ill patients, presence of pain was subjective, and mortality risk stratification models were not utilized in the study.  The study presented a strength of comparison complexity in evaluating sepsis versus all other critical illnesses (Biason et al., 2019). 

Based on this evidence summary, would you consider this qualitative research study as support for your selected practice problem? Explain your rationale.

 This qualitative research study would add great value to the practice problem of sepsis.  In utilizing the John Hopkins evidence-based practice tool the study completed by Biason et al. (2019) showed a level of evidence of I by being a randomized controlled trial.  A quality rating of good was achieved through consistent results, utilizing a control group, current literature review, and definitive conclusions (Newhouse et al., 2007).   

References

Biason, L., Teixeira, C., Haas, J., Cabral, C., & Friedman, G. (2019). Effects of sepsis on morbidity and mortality in critically ill patients 2 years after intensive care unit discharge. American Journal of Critical Care, 28(6), 424–432. https://doi.org/10.4037/ajcc2019638 (Links to an external site.)

Chamberlain College of Nursing. (2021). NR-714 Week 2: Quantitative Inquiry and Data. Online lesson. Adtalem Global Education

Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C., & White, K. M. (2007). Johns hopkins nursing – evidence-based practice model and guidelines (newhouse, john hopkins nursing evidence-based practice model and guidelines) (1st ed.). Sigma Theta Tau International.

I need a comment for this Discussion Board with at least 2 paragraphs and 3 sources no later than 5 years. 

Instructions:

Perform a database search on urinary tract infections. There are various levels of evidence. Select the article that has the best level of evidence.

Please write an 150 word discussion with a 50 word reply to a colleague answering the following questions:

1. Describe why this article was selected and how it meets the criteria to be considered the best level of evidence.

2. Describe if this is a peer-reviewed article. Why is it significant to find peer-reviewed versus non–peer-reviewed articles for research?

3. Describe the nurses’ role in research in this type of research.

***Include citations (according to 7th edition APA manual) in the body of the discussion board and a reference in APA format at the bottom of the initial discussion.**

*** UPLOADING RUBRIC W/ REQUIRED RULES AND STRICT GUIDELINES***

*** UPLOADING 1ST REFERENCE REQUIRED FROM REQUIRED TEXTBOOK; TEXTBOOK LINK***

*** INLUDING LINK FROM ARTICLE I CHOSE FROM DATABASE BELOW***

–    978-0-387-72659-5_15 (springer.com) 

–  Urinary Tract Infection | SpringerLink 

*** PLEASE USE CORRECT APA FORMAT***

** 50 WORD REPLY IS OPTIONAL**

ANY QUESTIONS PLEASE LET ME KNOW.

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

• Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
• Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
• Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.  

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

· Metformin 500mg BID 

· Januvia 100mg daily 

· Losartan 100mg daily 

· HCTZ 25mg daily 

· Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

Post a response to each of the following:

· List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. 

· Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. 

· Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. 

· List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. 

· List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. 

· For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

· Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.