- ItemRapid appraisal project: Marik protocol for sepsis management(2018-11)Do patients diagnosed with severe sepsis who are treated with hydrocortisone, thiamine, and vitamin C have a better prognosis than those treated with the current standard practice? Through extensive searching of the Cochrane Collection, PubMed, and the Bryan College of Health Sciences Library, this medication regimen effectiveness was analyzed. To research this regimen, three primary research articles were chosen. Because this topic is new, available research was limited. Criteria for the primary article included the full medication regimen, a critical care setting, and the diagnosis and prognosis of sepsis. Additionally, one systematic review was chosen that analyzed the effectiveness of hydrocortisone in the treatment of sepsis. To supplement the article and review, a registered nurse was interviewed. With over 30 years of experience in the intensive cardiac unit at an urban hospital, she detailed her experiences with sepsis and shared that this protocol has been in discussion at intensive care conventions. Through the research, we found that this protocol decreased mortality by 32%, decreased the need for dialysis by 17%, and decreased vasopressor use by an average of 35 hours. Ultimately, this medication regimen shows great potential but will need to be studied further before it becomes standard practice.
- ItemNitrous oxide use in labor(2019-05)There is a great amount of literature exploring the effects of nitrous oxide (N2O) as a method of pain relief for laboring women. However, a majority of this research was published prior to 2010 and conducted in other countries. Since the emergence of epidural analgesia, N2O has not been the method of choice for labor pain management in the United States. Despite this trend, many hospitals have recently seen a reemergence of this less expensive and less invasive gas. Many women are choosing this method of pain relief due its benefits of having a shorter half-life, ability to encourage feelings of empowerment, and the requirement of fewer interventions that would be needed with epidural analgesia (e.g., bladder catheterization, intravenous fluid bolus, blood pressure monitoring). This gas is also an appropriate option for women if epidural analgesia is contraindicated, ineffective, or inadequate. Since this drug is self-administered by the patient, there are minimal risks of adverse effects for hospital staff and caregivers. Side effects of N2O inhalation include dizziness, nausea, vomiting, and drowsiness. Research on this intervention has not found a significant relationship between maternal N2O inhalation and neonatal APGAR scores. Overall, many studies are indicating positive benefits of N2O inhalation as a method of pain management during labor. Unfortunately, a majority of these studies were of poor quality with bias and inconsistency among expected outcomes. Furthermore, many of these studies are qualitative, gaining mothers' views of N2O use after deliveries. Clearly, further quantitative research regarding this form of pain management during labor is needed to accurately assess its effectiveness as well as the potential risks to mother, neonate, and medical staff.
- ItemDelayed Umbilical Cord Clamping(2019-05)The purpose of this research project was to look at the effect and assess the delaying of the umbilical cord clamping at birth. The articles obtained were from CINAHL and PubMed. The PICO question that gave results included: in neonates (greater than 34 weeks gestation), does delayed umbilical cord clamping, compared to early umbilical cord clamping, affect hematocrit/hemoglobin. This evidence-based practice of delayed cord clamping has been implemented in medical centers around the country and world as the beneficial effects has been shared through research and trials. Delayed umbilical cord clamping, as compared to early, has shown benefits including a decrease in mortality, an increase in the hemoglobin and hematocrit, and an overall increase in the baby's well-being, especially in pre-term infants. This research included data sources from randomized controlled trials and systematic reviews - meta analysis. The studies can be applied to a general population through the labor and delivery process. One specific finding of the research articles was the commonalities in relationship to hematological components related to delayed cord clamping. The intervention group saw a higher hematocrit and hemoglobin without increases in hyperbilirubinemia or symptomatic polycythemia. This leads to an increase in oxygen available to the newborn, which helps to increase the oxygen saturation and better perfuse the organs. The infant's vital signs will show an improvement including the cardiac output, heart rate, and blood pressure. Other findings included in the research were a decrease in mortality in infants and a higher APGAR score at birth. The delaying of the clamping caused a reduction of the incidence of blood transfusions, infection, and sepsis. Many of the benefits were documented later on in the infants' life. This included a lower incidence of anemia and iron deficiency. The selected studies gave collected data and reviewed bias related to delayed versus early umbilical cord clamping. The researchers saw many benefits through the subjects including improvement to the infant's health and development throughout their lifespan. The benefits included an increase in hemoglobin and hematocrit, a higher APGAR score, lower bilirubinemia, and lower incidence of hospital mortality. Delayed umbilical cord clamping has shown to be safe, beneficial, and is now being implemented in health care facilities around the world.
- ItemRapid Appraisal Project: Nutrition Related to Wound Healing(2019-04-22)Through clinical experiences amongst patients with wounds, an inquiry arose regarding interventions that could be used to expedite the healing process—specifically nutrition. Through extensive searching of Bryan Fusion, inclusive of scholarly works found in databases such as PubMed and CINAHL, articles were found comparing wound healing and nutrition. An interview with an expert clinician was also conducted. A primary outcome of this literature review process was the finding that malnutrition is highly prevalent in patients with pressure ulcers. According to our research, proper nutrition and supplementations are proven to be beneficial in wound prevention and healing. The nutrients that had the greatest effect on wound healing include arginine, zinc, antioxidants, and protein supplementation.
- ItemNutrition Related to Wound Healing(2018-12)Through clinical experiences amongst patients with wounds, an inquiry arose regarding interventions that could be used to expedite the healing process—specifically nutrition. Through extensive searching of Bryan Fusion, inclusive of scholarly works found in databases such as PubMed and CINAHL, articles were found comparing wound healing and nutrition. An interview with an expert clinician was also conducted. A primary outcome of this literature review process was the finding that malnutrition is highly prevalent in patients with pressure ulcers. According to our research, proper nutrition and supplementations are proven to be beneficial in wound prevention and healing. The nutrients that had the greatest effect on wound healing include arginine, zinc, antioxidants, and protein supplementation.