Systematic Review Essay

Indeed, "new and validated knowledge that forms the basis j Y for evidence-based practice (EBP) most commonly is discovered in academic settings. But findings need to be translated into a protocol or guideline that can be used to guide practice," according to Conner, (2014, p.40). Evidence-based projects have lead to many improved clinical practice changes at the bedside and healthcare in general; and they are highly promoted and supported by different healthcare organizations.

Acetaminophen is a non-opioid analgesic. We are not sure about how acetaminophen reduces the pain. It could have an inhibitory effect on central prostaglandin synthesis (cyclooxygenase (COX)-2) as well as increase the pain threshold. Acetaminophen cure fever by inhibiting the formulation and release of prostaglandins in the CNS. It stops endogenous pyrogens at the hypothalamic thermoregulator center. Acetaminophen is effective on curing fever, and may also relieve mild pain caused by cancer. Compared with Ibuprofen, they have very similar effectiveness. Acetaminophen provides a faster and greater temperature drop than aspirin. Acetaminophen may cause vomiting, constipation, nausea, pruritus, and agitation. For more serious circumstances,

Although the mechanism of action of acetaminophen is unclear, it is generally believed to work the same was as ibuprofen. Ibuprofen and acetaminophen produce therapeutic effects by reversibly inhibiting cyclooxygenase and thus blocking the synthesis of proinflammatory prostaglandins, prostacyclins and thromboxanes from arachidonic acid. The effects of these prostanoids include lowering the pain threshold thereby exaggerating pain perception. Inhibiting the synthesis of these prostanoids increases the pain

Postoperative surgical pain can often be moderate to severe leaving the client in a state of discomfort that requires the administration of opioid analgesic medications. Morphine intravenous (IV) patient-controlled analgesia (PCA) is commonly provided through a pump to treat postoperative surgical pain, but with advances in the medication administration field, a fentanyl iontophoretic transdermal system (ITS) has become another popular method (Lindley, Pestano, & Gargiulo, 2009). Morphine and fentanyl are similar medications in that they are both opioid analgesics and are both equally effective to reduce pain, but they offer differences through their administration techniques, comfort for the client, and providing care in a timely manner by the nurse. The nurse must take into consideration these differences to choose the proper medication for their specific client.

The institute ethics committee of JIPMER approved this study and written informed consent was obtained from all patients. This was a single center double blind randomized study. Patients between 18 to 60 years undergoing oral and maxillofacial surgery at Dentistry department of JIPMER were randomized in a double blind fashion to receive intravenous paracetamol 1gram over 20 minutes prior to induction followed by normal saline infusion or intravenous dexmedetomidine 1µg/kg over 20 minutes prior to induction followed by 0.5µg/kg/hr. Simple randomization was done by the opaque sealed envelope technique. One of the anaesthetist apart from investigator randomly opened one of the opaque sealed envelope and prepared the drugs accordingly. We excluded

Rheumatoid Arthritis has been subject of numerous studies and researches in the look for a better understanding of how it effects the individuals diagnosed with it. There is a higher incident of females diagnosed with RA than male as well as a relationship with genetic and environmental factors involved. Around one percent of the world population is affected by RA; therefore, diverse studies have been performed to understand how the lives of the diagnosed patients can be impacted by the disease. For example, how RA affects the mobility, safety and activities of daily living in general as well as the development of interventions to better approach RA. On

This significant difference (p=0.07) in pain score is more noticeable during POD0 (FNB=2.91; liposomal bupivacaine=3.84), but over the next 24 hours after surgery it diminishes to identical. ROM showed improved flexion in the FNB group (FNB=101 degrees Passive flexion vs: liposomal bupivacaine group=94 degrees passive flexion).This result was statistically significant (P = 0.001). The amount of flexion between the two groups did appear to level out after the first 24 hours of surgery. No statistically significant differences in nausea (P = 0.17) and vomiting (P = 0.64) between the FNB and liposomal bupivacaine groups. Surprisingly, the patient in FNB group on POD0 required significantly fewer opioids than the liposomal bupivacaine group (13.9 mg vs 25.5 mg, respectively) but on POD 1 the liposomal bupivacaine group patients required

Even when kids don’t remember the abuse, they sometimes subconsciously will develop negative behaviors. A. Danese and M. Tan, in their journal article “Childhood Maltreatment and Obesity: Systematic Review and Meta-analysis”( 2014), explain that child maltreatment and obesity are often related. Danese and Tan use factual evidence and a meta- analysis of 41 studies conducted to support that “Improving the psychosocial environment children live in might contribute to the primordial prevention of obesity and its consequence”( Danese and Tan 552). The authors’ purpose is to educate readers on the effects child abuse has on an individual's health in order to lower the obesity rates by helping children who are being mistreated. By keeping their article extremely formal and

CRITICAL APPRAISAL OF A SYSTEMATIC REVIEW AND NARRATIVE REVIEW RELATED TO COMPUTERISED PHYSICIAN ORDER ENTRY SYSTEM

The author’s intention is to identify an aspect of clinical practice which lends itself to change at a micro level. The definition of a micro-change is an intervention of change aimed at the individual or the way small teams work. The micro-level change is not to be confused with a service change (Walsh, 2009).

Postoperative nausea and vomiting (PONV) is an unpleasant experience that distresses surgical patients during the first 24 hours after a surgical procedure (1-8). The general incidence of vomiting is about 30%, the incidence of nausea is about 50%; and in high-risk patients, the PONV rate can be as high as 80% (2, 3, 5, 6, 8). PONV is a dangerous post-operative complication that increases the chances of developing threatening wound dehiscence, hematoma formation, aspiration, esophageal rupture, dehydration and increases intraocular and intracranial pressures due to acute blood pressure elevations (2, 4, 7, 9). According to the Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, a combination of antiemetic medications is recommended as the best treatment for patients with moderate and high risk factors for PONV (6). PONV can be classified as either early PONV (0-2 hours) or delayed PONV (2-24 hours) (6). Post-discharge nausea and vomiting (PDNV) are episodes that occur after the patient has left the hospital (6).

Evidence-Based Practice: In Nursing, the Research Process, and Patient Outcomes Evidence-based practice (EBP) is important in nursing because it is translated into clinical care that is backed by research studies that have been proven to have significant findings towards the solution to a clinical problem. Using the proper research process allows for valid evidence that is needed for EBP to be valuable to the general patient population. EBP improves patient outcomes by improving the quality of care provided, limiting risks while improving benefits, and decreasing the overall cost of patient care.

On March 22, 2014, Annemarie K. Loth, Deborah A. G Drabrick, Ellen Leibenluft, and Leslie A. Hulvershorn released an article called Do Children Externalizing disorders predict adult depression? A Meta-Analysis. This article is located in the J Abnorm Child Psychol (2014) vol. 42, page 1103-1113. The given study was to analyze children with symptoms or the disorder of depression and the growth of adult depression. They preformed a statistical procedure for combining date from multiple to achieve their meta-analysis result. It was believed that children's psychopath disorders would be able predict depression for adulthood. The researchers hypothesis believed that there will be a connection between adult depression happen due to children showing

1. Post-operative nausea and vomiting (PONV) is one of the most common and distressing side effects of surgery (Watcha and White, 1995; Tate and Cook, 1996a). 2. With a multifactorial aetiology, the incidence of PONV can be affected by surgical procedure, use of anaesthesia and individual patient and/or post-operative factors (Watcha and White, 1992; Cohen et al., 1994; Rowbotham, 1995). 3. Development of PONV may result in a number of serious complications including aspiration, dehydration, electrolyte disturbance, wound disruption and gastric bleeding (Kenny, 1994; Blinkhorne, 1995). 4. Evidence from a range of studies would suggest that patients find PONV more debilitating than pain, with some prepared to tolerate some degree of pain as

Although narcotics are effective in attenuating pain during the perioperative period, obese patients undergoing surgery are susceptible to complications well into the postoperative time frame due side effects such respiratory depression. Dexmedetomidine offers a safer alternative to administration of narcotics in the bariatric population. Singh et al. (2017) state that the sedative effect of dexmedetomidine is comparable to the opioid remifentanil but without the adverse effects. Prompting formulation of the question “Does dexmedetomidine decrease pain without respiratory depression compared to narcotics during the perioperative period in obese patients?”. This PICO question guided the search for evidence to evaluate the comparison between dexmedetomidine and narcotic use in the obese surgical patient.