QUESTION 1. a. What are the methods a nurse can use to gather cultural information from patients? b.How does cultural competence relate to better patient care? c. Discuss the ways in which a nurse demonstrates cultural competency in nursing practice.

QUESTION 2 a. Discuss why nutrition is a central component in health promotion. b.What are some of the nutritional challenges for emerging populations? c. What roles do nutritional deficiency and nutritional excess play in disease?

 
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Hi,

I would like someone to review the case study from attachment very careful (please review several times). From the case study above, please compare the diagnosis with I have below and assist me with any new diagnosis with the table in section 2. Please create from most to least important diagnosis.

PLEASE COMPLETE BY 5 PM TODAY.

1. HOMEWORK INSTRUCTIONS

“Differential Diagnosis Table

a. Complete a differential diagnosis table for this patient (see below)

i. A differential diagnosis list is a list of all the possible diagnoses this patient could have based on the symptoms the patient presents with, the available history and the physical exam. Examine what you know about this patient, and consider the pathophysiology as you make your list of possible diagnoses.

ii. You should be able to generate a list of at least 4-5 possibilities, though there is space for more if you would like.

iii. Put them in a list of most likely being number 1, to less likely.

1. Your number one diagnosis is the one you think this patient has, given the history and physical exam. This is the most likely diagnosis given that there are more clinical manifestations and findings in the history and exam that support this diagnosis.

2. Include any differential that you think is appropriate for this patient, given the information you have, but make sure it is in the order of most likely.

3. Be specific in your possible diagnosis. Do not use generic diseases or diagnoses. If there are more than one type of a disease, list each separately, as likely the pathophysiology is different.

THIS IS MY OWN DIAGNOSIS

 

Possible Diagnosis (listed in order   of likelihood)

Signs and Symptoms seen in This patient   that make you consider this as a diagnosis

 

1.Spinal tumors

-Fever, weakness in his feet and ankles, and inability to walk. Unable   to walk secondary to weakness, weight loss, history of smoking for 20   years, obesity (32% of BMI), back pain and wake up at night, throbbing, achy   low back pain, buttock and legs, numbness, tingling and burning sensation in   feet, toes, and fingertips, bladder problem with one time incontinence, positive   with neuro exam.

 

2.Type 2 Diabetes

Numbness, tingling, and burning sensation in feet, toes, and fingertips, fatigue,   high fat and calories intake, sedentary lifestyle.

 

3.Peripheral artery disease

Smoking, over 50, leg numbness or weakness, painful with activities

 

4.Pernicious anemia and iron deficiency anemia

Moderated alcohol and low iron diets (not eating redmeat).

 

5. Stomach flu

N&V and fever

 

6.

 

7.

 

8.

2. PLEASE COMPARE WITH THE DIAGNOSIS ABOVE AND NEW DIAGNOSIS THAT YOU HELP ME TO CREATE IN THE TABLE BELOW WITH CLEAR SIGNS/SYMPTOMS OF THE PATIENT AND RELATED TO THE PATHOPHYSIOLOGY (As many as diagnosis on the table below).

 

Possible Diagnosis (listed in   order of likelihood)

Signs and Symptoms seen in This patient   that make you consider this as a diagnosis

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

1

Nursing 523 Midterm

History of present condition: George is a 50 yo business executive who presents with complaints of weakness in his feet and ankles, and inability to walk. His toes and feet are numb and tingly. He feels like his is unable to walk secondary to weakness in his legs. His low back is painful, and he had an episode of urinary incontinence this morning. His fingertips are also tingly. He’s brought by his wife, and with his 2 nephew’s to help him walk. He feels like he is getting much worse. Past medical and surgical history

� Intermittent back pain. He states he has a long standing problem with his back with occasional exacerbations after a weekend of working in the yard. Sometimes he will engage in physical activity, like playing softball or basketball on the weekends, which will cause him to have problems for several days. 5 days ago, he was cutting and stacking firewood, but didn’t finish because he didn’t feel very well. Doesn’t remember hurting back but was doing some twisting and lifting, which has caused him back pain before.

� No surgeries Allergies

� Medicinal allergies: Denies � Environmental allergens: Denies � Food allergens: NKDA

 

 

2

Medications: Ibuprofen prn. Lifestyle General: Works for a telecommunications industry as an executive. Some travel, most recently 2 months ago to Chicago. Married, no kids. Physical activity: Fairly sedentary. Limited exercise except on weekends. Sleep: Has not been sleeping well in last week secondary to GI distress (resolving) and back pain. High risk behaviors: ETOH moderately on weekends, none in last week secondary to vomiting and diarrhea episode. Smokes 1ppd x 20 years. No recreational drugs. Diet Usually normal diet, somewhat high in fat and calories. Trying to “do better” with chicken and fish instead of red meat, but had recent vomiting and diarrhea after eating chicken, and hasn’t been interested in chicken since. Relevant review of systems

ROS: General malaise, some wt loss over last week. Cardiovascular: Denies chest pain Respiratory: Denies cough, shortness of breath. Gastrointestinal: Denies present nausea, vomiting or diarrhea. Had 3-4 day course of v/d (nonbloody) last week after eating chicken. Resolved. Drinking fluids. Not much appetite. Genitourinary: No dysuria. Incontinence of urine this am. Musculoskeletal: Feels weak, mostly in legs. Throbbing, achy low back pain, buttock and legs. Integumentary: Denies rashes or bruising. Neurological: Denies headache, neck pain. Numbness, tingling and burning sensation in feet, toes and fingertips.

Physical exam BP: 105/66 RR:16 temp:100.8 pulse:62 ht:70 in wt:220 lbs RA Sat 97%

� General: awake and alert, oriented x 4. Appears tired, but nervous, sitting in wheelchair.

� HEENT: normocephalic, atraumatic. Pupils =, reactive to light and accommodation. Ears clear, oropharynx without signs of redness, lesions. Airway patent. Speech clear. Neck supple. Full range of motion.

 

 

3

� Lungs: clear to auscultation bilaterally. Easy unlabored on room air. � CV: S1S2, no rubs, no murmurs. � Abdomen: mild abdominal obesity, otherwise normal. Soft, nontender. � Extremities: warm, well perfused. No edema. � Back: No midline pain to thoracic or lumbar spinous processes. Atraumatic.

Tender to palpation to bilat lower lumbar paraspinal region. � Skin: no rashes or lesions � Neuro: Cranial nerves II-XII grossly intact. Motor: 2+/5 bilat toe flexion and

extension, ankle flexion and extension symmetrically. Quads 3+/5 bilat and symmetric. All other muscle testing 5/5. Reflexes: Unable to obtain bilat ankles, 1+ bilat knees, biceps, brachioradialis 2+ triceps. Sensory: Dysesthesias in bilat legs below knees, sacral area and all fingers on exam to light touch. Unable to stand for exam secondary to weakness.

Hi,

I would like someone to review the case study from attachment very careful (please review several times). From the case study above, please compare the diagnosis with I have below and assist me with any new diagnosis with the table in section 2. Please create from most to least important diagnosis.

1. HOMEWORK INSTRUCTIONS

“Differential Diagnosis Table

a. Complete a differential diagnosis table for this patient (see below)

i. A differential diagnosis list is a list of all the possible diagnoses this patient could have based on the symptoms the patient presents with, the available history and the physical exam. Examine what you know about this patient, and consider the pathophysiology as you make your list of possible diagnoses.

ii. You should be able to generate a list of at least 4-5 possibilities, though there is space for more if you would like.

iii. Put them in a list of most likely being number 1, to less likely.

1. Your number one diagnosis is the one you think this patient has, given the history and physical exam. This is the most likely diagnosis given that there are more clinical manifestations and findings in the history and exam that support this diagnosis.

2. Include any differential that you think is appropriate for this patient, given the information you have, but make sure it is in the order of most likely.

3. Be specific in your possible diagnosis. Do not use generic diseases or diagnoses. If there are more than one type of a disease, list each separately, as likely the pathophysiology is different.

THIS IS MY OWN DIAGNOSIS

Possible Diagnosis (listed in order of likelihood) Signs and Symptoms seen in This patient that make you consider this as a diagnosis
1.Spinal tumors -Fever, weakness in his feet and ankles, and inability to walk. Unable to walk secondary to weakness, weight loss, history of smoking for 20 years, obesity (32% of BMI), back pain and wake up at night, throbbing, achy low back pain, buttock and legs, numbness, tingling and burning sensation in feet, toes, and fingertips, bladder problem with one time incontinence, positive with neuro exam.
2.Type 2 Diabetes Numbness, tingling, and burning sensation in feet, toes, and fingertips, fatigue, high fat and calories intake, sedentary lifestyle.
3.Peripheral artery disease Smoking, over 50, leg numbness or weakness, painful with activities
4.Pernicious anemia and iron deficiency anemia Moderated alcohol and low iron diets (not eating redmeat).
5. Stomach flu N&V and fever
6.  
7.  
8.  

 

 

2. PLEASE COMPARE WITH THE DIAGNOSIS ABOVE AND NEW DIAGNOSIS THAT YOU HELP ME TO CREATE IN THE TABLE BELOW WITH CLEAR SIGNS/SYMPTOMS OF THE PATIENT AND RELATED TO THE PATHOPHYSIOLOGY (As many as diagnosis on the table below).

Possible Diagnosis (listed in order of likelihood) Signs and Symptoms seen in This patient that make you consider this as a diagnosis
1  
2  
3  
4  
5  
6  
7  
8  
9  
10  
 
 
Do you need a similar assignment done for you from scratch? We have qualified writers to help you. We assure you an A+ quality paper that is free from plagiarism. Order now for an Amazing Discount!
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NB: We do not resell papers. Upon ordering, we do an original paper exclusively for you.

 Separate  each section in your paper with a clear heading that allows your  professor to know which bullet you are addressing in that section of  your paper. Support your ideas with at least one (1) source using  citations in your essay. Make sure to cite using the APA writing style  for the essay. The cover page and reference page are required. Review  the rubric criteria for this assignment.

 

Conduct a literature search to select a qualitative research study on the topic identified in Module 1. Conduct an initial critical appraisal of the study.

RESEARCH STUDY IS ATTACHED

Respond to the overview questions for the critical appraisal of qualitative studies, including:

  • What type of qualitative research design was utilized to conduct the study?
  • Are the results valid/trustworthy and credible?
  • How were the participants chosen?
  • How were accuracy and completeness of data assured?
  • How plausible/believable are the results?
  • Are implications of the research stated?
  • May new insights increase sensitivity to others’ needs?
  • May understandings enhance situational competence?
  • What is the effect on the reader?
  • Are the results plausible and believable?
  • Is the reader imaginatively drawn to the experience?
  • What are the results of the study?
  • Does the research approach fit the purpose of the study?
  • How does the researcher identify the study approach?
  • Are the data collection and analysis techniques appropriate?
  • Is the significance/importance of the study explicit?
  • Does the literature support a need for the study?
  • What is the study’s potential contribution?
  • Is the sampling clear and guided by study needs?
  • Does the researcher control selection of the sample?
  • Do sample size and composition reflect the study needs?
  • Is the phenomenon (human experience) clearly identified?
  • Are data collection procedures clear?
  • Are sources and means of verifying data explicit?
  • Are researcher roles and activities explained?
  • Are data analysis procedures described?
  • Does analysis guide directions of sampling when it ends?
  • Are data management processes described?
  • What are the reported results (descriptive or interpretation)?
  • How are specific findings presented?
  • Are the data meanings derived from data described in context?
  • Does the writing effectively promote understanding?
  • Will the results help me care for my patients?
  • Are the results relevant to persons in similar situations?
  • Are the results relevant to patient values and/or circumstances?
  • How may the results be applied to clinical practice?

 

Assignment Expectations:

Length: Clearly and fully answer all questions; attach a copy of the article
Structure: Include a title page and reference page in APA format. Your essay must include an introduction and a conclusion.
References:  Use appropriate APA style in-text citations and references for all  resources utilized to answer the questions. A minimum of one (1)  scholarly source for the article is required for this assignment.
Rubric:  This assignment uses a rubric for scoring. Please review it as part of  your assignment preparation and again prior to submission to ensure you  have addressed its criteria at the highest level.
Format: Save your assignment as a Microsoft Word document

  • © 2017 Sayed et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you

    hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).

    Therapeutics and Clinical Risk Management 2017:13 847–854

    Therapeutics and Clinical Risk Management Dovepress

    submit your manuscript | www.dovepress.com

    Dovepress 847

    O R i g i n a l R e s e a R C h

    open access to scientific and medical research

    Open access Full Text article

    http://dx.doi.org/10.2147/TCRM.S134153

    Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

    ashraf Othman sayed1

    nancy selim Zeidan2

    Dalia Monir Fahmy3

    hossam a ibrahim4

    1Department of Pediatrics, Children and Women’s University hospital, Minia University, el-Minya, egypt; 2Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, egypt; 3Department of Diagnostic Radiology, Mansoura University hospital, Faculty of Medicine, Mansoura University, Mansoura, egypt; 4Department of surgery, Faculty of Medicine, Cairo University, Cairo, egypt

    Background: Diagnosis of appendicitis in children is clinically challenging. Computed tomography (CT) is the gold standard for diagnosis; however, radiation exposure early in life

    is a concern with this technique. Therefore, in this study, we aimed to evaluate the diagnostic

    reliability of low-dose CT, pediatric appendicitis score (PAS), and abdominal ultrasound (US)

    in children with acute appendicitis, to reach a safe diagnosis.

    Patients and methods: This retrospective study was conducted on 140 children who were admitted with clinically suspected acute appendicitis (45 with positive appendicitis and

    95 children with negative appendicitis). Low-dose CT was performed, and PAS was retro-

    spectively calculated for all subjects. US was initially performed for 38 subjects. All results

    were compared with the final diagnosis reached by an operative, histopathological analysis

    and follow-up.

    Results: Low-dose CT showed a sensitivity, specificity, and accuracy of 97.8%, 100%, and 99.3%, respectively. At a cutoff value $5, PAS showed a sensitivity, specificity, and accuracy

    of 95%, 84%, and 89%, respectively. Abdominal US examination showed sensitivity, specificity,

    and accuracy of 55.6%, 85%, and 71%, respectively. Implementing Poortman’s model resulted

    in higher accuracy (92%) of US. There was a significant difference in accuracy between a

    low-dose CT and PAS on one side and between Poortman’s model and US examination on the

    other side. A diagnostic scheme was suggested using PAS as the excluding tool (PAS #2 send

    home and $7 send directly to operation) followed by US examination and reserving low-dose

    CT for inconclusive cases. This scheme would eliminate the use of CT for at least 33.7% and

    in 7 cases who had initial US examination.

    Conclusion: Although CT remains the most accurate and less operator-dependent diagnostic tool for pediatric appendicitis, the radiation hazards could however be minimized using PAS

    as an excluding tool and US as the primary imaging modality followed by low-dose CT for

    inconclusive cases only.

    Keywords: acute appendicitis, children, pediatric appendicitis scoring system, PAS, computed tomography, CT, ultrasound, US

    Introduction Acute appendicitis remains the most common acute surgical condition in children

    and a major cause of morbidity; appendectomy is still the mainstay of treatment.1

    Delayed intervention leads to dramatic complications such as perforation and abscess

    formation while rushing to surgery is associated with a high negative appendectomy

    Correspondence: Dalia Monir Fahmy Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University hospital, Mansoura University, el-gomhoria street, Mansoura, 35516, egypt Tel +20 109 104 3679 Fax +20 50 229 5025 email daliamonir2525@gmail.com

    Journal name: Therapeutics and Clinical Risk Management Article Designation: Original Research Year: 2017 Volume: 13 Running head verso: Sayed et al Running head recto: Reliability of PAS, US, and CT in the diagnosis of pediatric appendicitis DOI: http://dx.doi.org/10.2147/TCRM.S134153

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    sayed et al

    of up to 15%–30%.2 Diagnosis of appendicitis in children is

    challenging, not only because there are so many other non-

    surgical conditions that mimic appendicitis,1 but also because

    there are difficulties in communication and examination.3

    In many hospitals, including ours, pelvic–abdominal

    computed tomography (CT) is considered the gold standard

    diagnostic tool for the diagnosis of appendicitis in children

    owing to its high sensitivity and specificity.4 CT scan has

    certainly saved a significant number of patients from under-

    going unnecessary surgeries but has also caused unnecessary

    radiation exposure in them. Recent studies have reported that

    the risk of radiation exposure early in life is up to 25 mSv

    per study, which has raised concern regarding the increased

    incidence of cancer in pediatric patients.5,6 Another study

    predicted that approximately 29,000 future cancer cases will

    be linked to CTs performed in the year 2007, with the largest

    proportion coming from pelvic–abdominal scans.7 Therefore,

    in order to decrease radiation exposure, several protocols of

    modified technical parameters (tube voltage, tube current,

    and slice thickness) have been implemented.8

    Graded compression abdominal ultrasound (US) is a

    widespread bedside examination tool which costs less than

    CT and poses no radiation hazards but has low sensitivity and

    is operator-dependent. Pediatric appendicitis score (PAS) is

    a commonly cited appendicitis clinical scoring system that

    was developed specifically for children by Samuel.9 To our

    knowledge, there are no previously published studies that

    investigated PAS performance in comparison to abdominal

    US and low-dose CT in our region.

    Therefore, we aimed to evaluate the diagnostic reliability

    of low-dose CT, PAS, and abdominal US examination in

    children with suspected acute appendicitis, in order to reach

    a safe diagnosis with less radiation hazard.

    Subjects and methods Design and study population This is a retrospective cross-sectional study conducted over

    18 months from March 2015 to September 2016 at a major

    urban institution. Ethical approval from the Ethic Committee

    of Dar Al-Shifa Hospital was obtained for this study. The

    committee waived the need for an informed patient consent

    (from parent or guardian) owing to the retrospective nature

    of the research and as it did not seem to jeopardize patient

    confidentiality, privacy, or safety.

    inclusion criteria All children of both sexes between the age of 4 and 18 years

    who were admitted with clinically suspected acute appendi-

    citis were included in this study.

    exclusion criteria Children aged below 4 or above 18 years at the time of

    operation, or with incomplete medical records, or those

    who underwent appendectomy incidentally, or with chronic

    abdominal pain were excluded from this study.

    Result comparison with final diagnosis The PAS and imaging (CT and US) results were compared

    with the final diagnosis reached by surgery and histopatho-

    logical analysis or by follow up.

    Clinical and laboratory assessment The following data were collected from the automated and

    nonautomated medical records in the hospital: age, gender,

    duration of abdominal symptoms (days), and weight (kg).

    PAS values were calculated retrospectively for each

    patient according to the original PAS definition.9 The

    8 components of PAS are as follows: fever, anorexia, nausea/

    vomiting, migration of the pain to the right lower quadrant

    (RLQ), tenderness on light palpation of RLQ, cough/

    percussion/heel tapping tenderness at the RLQ, leukocytosis,

    and polymorphonuclear neutrophilia; all components of

    PAS were scored 1 point, except, right quadrant tenderness

    and cough/percussion/heel tapping tenderness were scored

    2 points (Table 1). Clinical assessment was performed by

    licensed pediatricians in the emergency room upon the initial

    admission of the patients.

    Radiological imaging Computed tomography All subjects (n=140) included in this study had CT examina- tion of the abdomen and pelvis, which was performed after

    fasting for at least 4 hours prior to scanning. Our protocol

    included intake of 1,000 mL of oral contrast solution (non-

    ionic) over a period of 90 min, followed by pre- and post-

    contrast phase (venous). However, in certain circumstances,

    such as severe vomiting or urgent cases that were planned for

    Table 1 Components of pediatric appendicitis score

    Signs/symptoms Point value

    nausea/emesis 1 anorexia 1 Migration of pain to RlQ 1 low-grade fever ($38.0°C) 1 RlQ tenderness on light palpation 2 Cough/percussion/heel tapping tenderness at RlQ 2 leukocytosis (.10,000/mm3) 1 left shift (.75% neutrophilia) 1 Total 10

    Abbreviation: RlQ, right lower quadrant.

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    Reliability of Pas, Us, and CT in the diagnosis of pediatric appendicitis

    operation soon after CT scan, oral intakes of contrast were

    eliminated from our protocol.

    CT scan was performed using a Siemens SOMATOM

    defined Flash dual source 128 multi-detector scanner

    (Siemens Medical Solutions, Forchheim, Germany): tube

    voltage, 100 kVp; tube current, 87/190 MA; slice thick-

    ness, 6 mm; and 40 mL Xenetix® (Guerbet, Gorinchem, the

    Netherlands) at 4 m/s. Postcontrast scan was performed 60 s

    after intravenous injection of Xenetix 350. The low-dose

    technique was implemented and a size-specific dose estimate

    (SSDE), an approximation of absorbed dose incorporating

    patient diameter, and effective dose (ED) was calculated

    for each scan.

    image analysis CT images were reviewed by a senior radiologist (DF) with

    15 years’ experience in abdominal imaging, who was blinded

    to the clinical findings and laboratory results. The criteria

    for diagnosis of acute appendicitis included the following:

    swollen appendix (outer diameter exceeding 6 mm) with

    or without fecolith, enhanced walls, and peri-appendiceal

    strands. The signs of perforation included the following: free

    intra-peritoneal air and excess peri-appendiceal, pelvic, or

    abdominal fluid. CT findings were interpreted as negative if

    an appendix was not visualized, had an outer diameter of less

    than 6 mm, and had absence of peri-appendiceal strands.

    Ultrasound examination All US examinations were performed using a curved

    3.5–5.0 MHz array and a linear 6 MHz array (ultrasound

    machine GE volusone E8 and E10). The criteria for diagno-

    sis of acute appendicitis were as follows: local transducer

    tenderness, noncompressible appendix, a thickened appendix

    (diameter greater than 6 mm), presence of an appendicoliths,

    peri-appendiceal fat infiltration, and free fluid adjacent to

    the appendix. In addition to a routine abdominal and pelvic

    US, all ultrasound examinations were performed in our

    institution by licensed general radiologists with at least

    5 years’ experience.

    Operative and histopathological analysis Surgery was performed by a consultant general surgeon with

    more than 20 years’ of experience. The existence of polymor-

    phonuclear leukocytes, lymphocytes, or plasma cells in appen-

    diceal biopsy was considered positive for appendicitis.

    Negative appendectomy was defined as, 1) an operation

    with a preoperative diagnosis of appendicitis, and 2) absence

    or minimal acute inflammatory cells in the case of appendec-

    tomy, or normal appearance of the appendix.

    Follow-up Patients who had a stable clinical condition and with a nega-

    tive CT scan for appendicitis were sent home and received a

    follow-up phone call after 1 week to assess their condition

    and cessation of symptoms. Patients, who had other diseases

    that caused acute abdominal pain other than appendicitis,

    discovered by imaging and laboratory tests, were treated

    according to their condition, as usual.

    statistical analysis IBM SPSS software package (Statistical Package for Social

    Sciences, version 20 for Windows) was used to analyze data.

    A 1-sample Kolmogorov–Smirnov test was used to assess

    whether the data were normally distributed. Continuous

    variables were presented as mean ± standard deviation and data were compared using an unpaired t-test. Categorical

    variables were expressed as numbers and percentages and

    analyzed for comparisons using chi-square test.

    For evaluating the predictive value of PAS in the diagno-

    sis of acute appendicitis, the sensitivity, specificity, positive

    predictive value (PPV), negative predictive value (NPV), and

    accuracy were calculated. In addition, receiver operating char-

    acteristic (ROC) curves were analyzed for the overall PAS

    performance. At the 5% level of significance, P-value less

    than 0.05 was considered significant in all statistical tests.

    Results A total of 140 patients were included in this study; 45 patients

    (positive appendicitis group) had surgery followed by

    histopathological analysis that confirmed acute appendi-

    citis. None had a negative appendectomy. The remaining

    95 patients (negative appendicitis group) had diseases other

    than appendicitis that were revealed by CT scan and clinical

    follow-up; none of these patients showed any complications

    related to a missed diagnosis of appendicitis (Table 2).

    Table 2 The final diagnosis in the negative appendicitis group (n=95)

    Diagnosis Number of cases

    Mesenteric lymphadenitis 42 Ovarian cyst 18 Colitis 25 enteritis 4 Crohn’s 1 intestinal obstruction 1 Diverticulitis 1 acute paniculitis 1 gastritis 1 Ureteric stone 1 Total 95

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    sayed et al

    Out of 140 patients included in this study, 77 were

    males and 63 were females. No significant difference was

    found between the positive and negative appendicitis groups

    regarding patients’ gender or weight. Patients’ ages ranged

    from 4 to 16 years and their mean age was (11±0.67 years). Table 3 summarizes the demographic data.

    All patients (n=140) included in this study underwent CT scan; it was the initial imaging in 102 patients and

    subsequently US imaging was performed for the remaining

    38 patients. Forty-four patients had radiological findings

    coping with acute appendicitis in CT examination, which

    was correlated with the histopathological findings: 16 showed

    dense fecolith; perforation was noted in 7 (3 of them were

    associated with fecolith as shown in Figure 1); and 1 was

    associated with an acute abscess. The most common loca-

    tion of the appendix with inflammation was pelvic region

    (19 cases, 42%) followed by retrocecal (16 cases, 36%).

    Table 4 summarizes radiological signs of patients.

    Only 1 patient was misdiagnosed by CT as having a

    normal appendix with a probably complicated right ovarian

    cyst. As this patient had persistent pain and tenderness in

    right iliac fossa, she was referred to laparoscopic surgery

    that revealed mild inflammation in her appendix with right

    corpus luteum cyst.

    CT examination showed a sensitivity of 97.8% (95%

    confidence interval [CI] =88.2%–99.9%), specificity of 100% (95% CI =96.2%–100%), PPV of 100%, NPV of 98.7% (95% CI =93.2%–99.9%), and an accuracy of 99.3%.

    Table 3 Demographic and clinical characteristics of all study patients (n=140)a

    Appendicitis (n=45)

    No appendicitis (n=95)

    P-value

    age (years) 13.1±4 13.2±3.9 P=0.885b

    t-value =−0.144 gender

    Male Female

    27 (60%) 18 (40%)

    50 (54%) 45 (46%)

    χ2=0.6699 P=0.413c

    Weight (kg) 45.65±18.2 47.2±19 t-value =0.586 P=0.559b

    symptoms duration (days)

    1.85±0.56 2.0±1.11 P=0.210b

    t-value =1.258 Pediatric appendicitis score

    5.34±1.15 2.48±1.11 t-value =−17.947 P,0.001b

    Notes: aContinuous variables are presented as mean ± standard deviation; categorical variables as numbers with percentages; bUnpaired t-test, cchi-square test.

    Figure 1 Preoperative postcontrast abdominal–pelvic CT scan of a child aged 14 years, who presented with abdominal pain and vomiting (Pas score =5). Notes: (A and B) Coronal reformatted images showed distended appendix with thick edematous walls, diameter 15 mm (long black arrow in A), which contains fecolith (short double black arrows in A). a tiny focus of air near its tip denoting contained perforation (white arrow in B); multiple associated regional and mesenteric lymph nodes (black arrows in B). (C) axial image showed distended appendix with thick edematous walls surrounded by peri-appendiceal fat stranding, and mild peri-appendiceal fluid (black arrow in C). Abbreviations: Pas, pediatric appendicitis score; CT, computed tomography.

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    851

    Reliability of Pas, Us, and CT in the diagnosis of pediatric appendicitis

    The mean dose-length product was 150 mGy/cm (ranging

    from 115 to 200 mGy/cm) and mean effective dose of radia-

    tion was 3.1 mSv (ranging from 2.2 to 3.4 mSv).

    The abdominal US examination was the initial imaging

    in 38 patients; it gave true positive results in 10 cases

    (26.3%), true negative in 17 cases (44.7%), false negative

    (missed appendicitis) in 8 cases (21%), and false positive

    (negative appendectomy) in 3 cases (7.9%). It showed a

    sensitivity of 55.6% (95% CI =30.8%–78.5%), specificity of 85% (95% CI =62.1%–96.8%), PPV of 76.9% (95% CI =52%–91%), NPV of 68% (95% CI =55.1%–78.6%), and an accuracy of 71%. In 2 patients (who were negative

    for appendicitis), abdominal US examination revealed right

    ovarian cysts 3 cm and 3.5 cm in diameter, respectively.

    Following Poortman’s model10 (which consisted of

    combination of US as the primary examination followed by

    CT in nondiagnostic US examination) yielded a sensitivity

    of 100% (95% CI =81.5%–100%), specificity of 85% (95% CI =62.1%–94.5%), PPV of 85.7% (95% CI =67.9%–78.6%), an accuracy of 92%, negative appendectomy rate of 7.9%,

    and no missed positive appendicitis cases. It alone would

    have avoided the use of CT in 13/38 cases.

    There was a significant difference between the PAS

    in positive and negative appendicitis groups (P,0.001).

    In this study, PAS score $5 was found to be the best cutoff

    point compatible with acute appendicitis; it resulted in a

    sensitivity of 95% (95% CI =29%–98%), specificity of 84% (95% CI =76%–90%), PPV of 82% (95% CI =73%–89%), NPV of 82% (95% CI =73%–89%), and accuracy of 89% (as shown in Figure 2). Further analysis of PAS showed

    that it is more useful as an exclusive tool; PAS $2 showed

    the highest sensitivity of 97.8% (95% CI =88.2%–99.9%) with only a single false negative case (missed appendicitis),

    whereas using higher cutoff value (PAS $7) showed the

    highest specificity 97.9% (95% CI =2.6%–99.7%) with only 2 cases of negative appendectomy (Table 5).

    On comparing low-dose CT, US, Poortman’s model, and

    PAS (using a cutoff value $5), low-dose CT showed the high-

    est accuracy, whereas US showed the lowest (Table 6).

    On one side, there was a significant difference in accuracy

    between low-dose CT scans and PAS (P,0.001), and on the

    other side, there was a significant difference between Poort-

    man’s model and US (P,0.02).

    Finally, we propose a diagnostic scheme that depends on

    the clinical score (PAS) as an initial diagnostic tool followed

    by US examination (if PAS is in the range of 3–6), preserving

    low-dose CT as the last step for cases with inconclusive US

    findings (as shown in Figure 3). Following this scheme would

    have eliminated the use of CT for at least 47/140 (33.6%)

    patients who had PAS #2 or $7. Unfortunately, not all

    patients included in this study had US examination; however,

    following this scheme for the remaining 38 patients who had

    initial US examination would have avoided the use of CT in

    7 cases (PAS 3–6 and positive US findings).

    Discussion Owing to its high diagnostic accuracy, CT is utilized widely

    in the management of appendicitis, but this trend is accom-

    panied by an increased radiation exposure and long-term

    Table 4 Computed tomography (CT) findings in positive appendicitis cases

    CT findings Patients (n)

    edematous wall 44 Perforation 8 Fecolith 16 Fecolith associated with perforation 3 enlarged regional and mesenteric lymph nodes 24 abscess 1 according to the appendix location

    Pelvic Retrocecal subhepatic anterior

    19 16 2 7

    Figure 2 Receiver operating characteristic curve for the performance of pediatric appendicitis score. Note: Area under curve (95% confidence interval) =0.951 (0.923–0.979).

    Table 5 Sensitivity and specificity of PAS values (using 3 different cutoff points) in all subjects (n=140), according to final diagnosis

    PAS cutoff Sensitivity Specificity Accuracy

    Pas $2 97.8% (95% Ci: 88.2–99.9)

    26.3% (95% Ci: 17.8–36.4)

    49.3%

    Pas $5 95% (95% Ci: 29–98)

    84% (95% Ci: 76–90)

    89%

    Pas $7 42.2% (95% Ci: 27.7–57.9)

    97.9% (95% Ci: 92.6–99.7)

    73%

    Abbreviations: PAS, pediatric appendicitis score; CI, confidence interval.

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    852

    sayed et al

    cancer risks.4 Two main pathways have been suggested

    to decrease these hazards and maintain high diagnostic

    accuracy; first to decrease the radiation dose by implement-

    ing a low-dose protocol in pediatric CT (image gently), and

    second, to decrease the utilization of CT by using a clinical

    score and US examination either alone or prior to CT, which

    can be performed in case of doubt (this decision should be

    made wisely).

    In the current study, a low-dose protocol was used for all

    patients with a mean radiation dose of 3.1 mSv. Although

    the low-dose technique resulted in reduced quality of images

    it did not affect the diagnostic accuracy. CT examination

    showed a sensitivity of 97.8%, specificity of 100%, and an

    accuracy of 99.3%. These results agree with other studies11–14

    in which the authors have reported no significant difference

    in sensitivity, specificity, negative appendectomy, or missed

    appendicitis rate between low-dose protocol and regular

    CT scan.

    In the current study, graded compression US was per-

    formed for a relatively small group of patients (38 cases). It

    had less sensitivity (55.6%), specificity (85%), and accuracy

    (71%) compared to CT, which could be attributed to 2 main

    reasons. First, all sonographic examinations were performed

    in our institution by a general radiologist, not by a pediatric

    sonologist; second, owing to the high percentage of a retro-

    cecal position of the appendix (36%) which hindered its

    detection by the US.

    Poortman et al10 suggested a diagnostic model for appen-

    dicitis that included graded compression US as the initial

    imaging modality followed by CT only in nondiagnostic US

    examination. Applying this model to a relatively small group

    of patients in the current study, it was found that primary US

    examination dramatically improved the sensitivity (100%),

    specificity (85%), and accuracy (92%), and yielded a nega-

    tive appendectomy rate of 8% and no missed appendicitis.

    These results are similar to those in the studies of Poortman

    et al10 (sensitivity of 100%, specificity of 86%, and negative

    appendectomy 8%), Ramarajan et al15 (sensitivity of 99%,

    specificity of 91%, and negative appendectomy 7%), and

    Thirumoorthi et al16 (sensitivity of 94.2%, specificity of

    97.5%, negative appendectomy 1.8%, and missed appen-

    dicitis 0%).

    One study reported an increasing trend of using US as

    the first imaging tool (about 69% instead of 32.6%) during

    the period from 2008 through 2013, whereas the use of CT

    was decreased.18 In the current study, US examination was

    the initial imaging modality in 27% of the cases suspected

    to have appendicitis. In contradiction to other studies which

    reported utilization of preoperative CT in about 40% of the

    cases,17–19 in our study, all patients undergoing appendectomy

    had received a preoperative CT, even if the patient had a US

    diagnosis of appendicitis. The reasons behind this could be

    that surgeons in our region have less trust in US results as

    compared to CT, which has higher sensitivity, specificity,

    and is indeed less operator-dependent. Although CT is more

    Table 6 Comparison of performance between CT, Us, Poortman’s model, and Pas

    PAS $5 (n=140)

    CT (n=140)

    US (n=38)

    Poortman’s model (n=38)

    sensitivity 95% 97.8% 55.6% 100% Specificity 84% 100% 85% 85% Positive predictive value 82% 100% 76.9% 85.7% negative predictive value 82% 98.7% 68% 100% accuracy 89% 99.3% 71% 92% negative appendectomy (false positive)

    4 (2.8%) 0 3 (7.9%) 3 (7.9%)

    Missed appendicitis (false negative)

    9 (6.4%) 1 (0.7%) 8 (21%) 0

    Abbreviations: CT, computed tomography; Pas, pediatric appendicitis score; Us, ultrasound.

    Figure 3 a suggested scheme for the diagnosis of appendicitis using Pas, Us, and low-dose CT scan. Abbreviations: Pas, pediatric appendicitis score; Us, ultrasound; CT, computed tomography; −ve, negative; +ve, positive.

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    853

    Reliability of Pas, Us, and CT in the diagnosis of pediatric appendicitis

    expensive than US, it is still less expensive than the cost of

    negative appendectomy or managing complications such as

    a perforated appendix. Furthermore, physicians find difficulty

    in convincing some parents of the diagnosis of acute appen-

    dicitis based only on clinical and US findings; they believe

    that CT scan can be less harmful than doing unnecessary

    appendectomy with possible surgical complications.

    The main drawback of US is that it is highly operator-

    dependent and its accuracy is affected dramatically by the

    examiner’s own experience. That is why CT scan utilization

    is higher in general hospitals (including our hospital) when

    compared to specialized pediatric hospitals. This is in agree-

    ment with Kotagal et al17 who noted 8 times higher use of

    CT in nonpediatric hospitals.

    Appendicitis scoring systems have been developed as a

    diagnostic tool to improve the decision-making process in

    patients with suspected acute appendicitis.20 In the current

    study, PAS score $5 was found to be the best cutoff point

    compatible with acute appendicitis, with a sensitivity of 95%,

    specificity of 84%, and an accuracy of 89%. However, there

    was still a significant difference in accuracy between low-

    dose CT and PAS. In this study, it has been found that rely-

    ing on a single PAS cutoff value would result in a negative

    appendectomy in 4 cases (2.8%) and missed appendicitis in

    9 cases (6.4%). Other studies suggested a modified pathway

    utilizing both PAS and imaging; Lourenco et al21 suggested

    that patients with a PAS of 1 to 3 could be discharged without

    further imaging examination, patients who had a PAS of 4

    to 6 would require further imaging examination, and those

    who had a PAS of 7 to 10 required surgical consultation

    without imaging examination. Similarly, Goldman et al22

    reported that a score of 7 or greater is valid for the diagnosis

    of appendicitis and a score of 2 or under is valid for the exclu-

    sion of appendicitis; and Zúñiga et al23 found that at PAS

    of #3 no patients were diagnosed with acute appendicitis,

    and if all patients with PAS of 8 or higher were operated on,

    there was a 5% rate of negative appendectomy.

    Similarly, in the current study, we found that using

    PAS #2 to exclude the diagnosis of appendicitis would have

    led to missing only 1 case (0.7%), whereas using PAS $7 as

    an indication for surgery would have led to negative appen-

    dectomy in 2 cases (1.4%); the rest of the patients having

    PAS between 3 and 6 were in need of further imaging studies.

    Accordingly, we have proposed a diagnostic scheme for acute

    appendicitis (Figure 3) that combines three diagnostic tools

    (PAS, US, and low-dose CT). Obviously, following this

    pathway will result in fewer cases of missed appendicitis or

    negative appendectomy as compared to using US or PAS

    alone, whilst also lowering CT utilization. We found that fol-

    lowing this scheme would have eliminated the use of CT for

    at least 33.6% (47/140) of the patients who had PAS #2 or

    $7, and in 7 patients who had initial US examination before

    CT. In contrast, these results disagree with Srinivasan et al24

    who found little benefit in performing CT for patients with

    PAS ,6 and negative US findings. Again, this could be

    attributed to the fact that our study was conducted in a general

    hospital and not in a tertiary pediatric center, and because

    US was performed by general radiologists and not pediatric

    sonologists. However, Rezak et al25 reported about 27% theo-

    retical decrease in CT utilization in children with suspected

    appendicitis with modified Alvarado score (5–7).

    In the current study, PAS that equals 5 or more was found

    to be the best cutoff value for diagnosis of appendicitis;

    however, this value is less than that found by several other

    studies including Samuel9 who created this score system

    back in 2002. This difference could be attributed to inher-

    ited difference between prospective and retrospective study.

    In the current study, examination of patients was performed

    by pediatricians and not by pediatric surgeons who could

    have underestimated the clinical signs. Other factors related

    to local population habits, such as giving children several

    analgesics and antipyretics without medical prescription,

    which could mask clinical signs. Another factor is difficulty

    in communication, as our hospital serves patients coming

    from multiple nationalities with different languages. To our

    knowledge, this is the first study to assess the validity of PAS

    as a diagnostic tool for pediatric appendicitis in our region;

    further large prospective multicenter study is recommended

    to clarify more its diagnostic value.

    There are some limitations in this study. First, the overall

    low number of cases included and the even fewer cases that

    had US examinations. As the number of patients who had

    US examination was less than those who had CT examina-

    tion, we were not able to apply Poortman’s model and our

    final diagnostic scheme for all cases. Second, all cases had

    low-dose CT examination performed, and we were not able

    to compare between low and ordinary dose CT in order to

    get true measurements of degree of dose reduction. Finally,

    the retrospective nature of this study hindered our ability to

    assess the feasibility of the suggested diagnostic scheme on

    daily work instead of assumption.

    Conclusion Although CT remains the most accurate and less operator-

    dependent diagnostic tool for pediatric appendicitis, radiation

    hazards could be minimized using PAS as an excluding tool

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    and US as primary imaging modality, followed by low-dose

    CT for inconclusive cases only.

    Disclosure The authors report no conflicts of interest in this work.

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    review article. Ital J Pediatr. 2017;43(1):15. 4. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis:

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    8. Patino M, Fuentes JM, Singh S, Hahn PF, Sahani DV. Iterative reconstruction techniques in abdominopelvic CT: technical concepts and clinical implementation. AJR Am J Roentgenol. 2015;205(1): W19–W31.

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    16. Thirumoorthi AS, Fefferman NR, Ginsburg HB, Kuenzler KA, Tomita SS. Managing radiation exposure in children – reexamining the role of ultrasound in the diagnosis of appendicitis. J Pediatr Surg. 2012;47(12):2268–2272.

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    25. Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg. 2011; 146(1):64–67.

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A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

In your Case Study Analysis related to the scenario provided, explain the following:

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Instructions

Overview/Description:

The final project for NSG6101 consists of the development of a novel research proposal specific to your role specialization. The project must include an intervention appropriate to nursing practice and consistent with your MSN role option. An alternative to the above includes the selection of a specialty organization to focus research proposals based on the priorities of that organization. Examples of these organizations could include (but are not limited to): Sigma Theta Tau International, American Nurses’ Foundation, Oncology Nursing Society, Association of Nurses in AIDS Care, American Psychiatric Nursing Association, American Association of Critical Care Nurses, National Association of Pediatric Nurse Associates and Practitioners, National League For Nursing, etc.

Throughout this course you have been developing various sections of the research proposal. This week you will assemble the final proposal (addressing faculty feedback). This paper is to be developed in APA format/style using the required template and not to exceed 8-10 pages (excluding title page/references/appendices).

Criteria:
Introduction

  • Background and Significance of Problem
  • Statement of the Problem and Purpose of the Study

Literature Review

  • Summary of the Evidence for the Proposed Study

Research Question, Hypothesis, and Variables with Operational Definitions

Theoretical Framework

  • Overview and Guiding Propositions(s) Described in Theory
  • Application of Theory to Your Study’s/Project’s Focus

Methodology

  • Sample/Setting: Number and criteria for inclusion and description of place in which data will be collected.
  • Sampling Strategy
  • Research Design: Type (e.g., Quasi-Experimental), description, and rationale for selection. 
  • Extraneous Variables (and plan for how controlled).
  • Instruments: Description, validity, and reliability estimates, which have been performed (on a pre-established measure). Include plans for testing validity and reliability of generating your own instrument(s).
  • Description of the Intervention
  • Data Collection Procedures
  • Data Analysis Plans
    • Describe plan for data analysis for demographic variables (descriptive statistical tests).
    • Describe plan for data analysis of study variables (descriptive and inferential statistical tests).

Ethical Issues

  • Describe ethical considerations and your plan to protect human rights.

Limitation of Proposed Study
Implications for Practice
References
Appendices

  • Informed Consent Letter
    • Procedure section is clear, described in detail, specific, and all inclusive. Written in lay language (as documented by reading level score). Includes risks and benefits relevant to study. Address assent (if applicable).
 
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Describe your acculturation experience as a new graduate to the culture of the nursing profession. How is it similar or different from the acculturation experience of a new nursing colleague who joined your team within the past year?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sourcesAcculturation Experience

     

    Describe your acculturation experience as a new graduate to the culture of the nursing profession. How is it similar or different from the acculturation experience of a new nursing colleague who joined your team within the past year?

     

    Submission Instructions:

    · Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

     

    Your assignment will be graded according to the grading rubric.

    Discussion Rubric
    Criteria Ratings Points
    Identification of Main Issues, Problems, and Concepts 5 points Distinguished

    Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.

    4 points Excellent

    Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.

    2 points Fair

    Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.

    1 points Poor

    Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.

    5 points
    Use of Citations, Writing Mechanics and APA Formatting Guidelines 3 points Distinguished

    Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

    2 points Excellent

    Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

    1 point Fair

    Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

    0 point Poor

    Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.

    3 points
 
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List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA).

  • How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.Elder Abuse

    · List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA).

    · How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?

     

    Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

    Your assignment will be graded according to the grading rubric.

    Discussion Rubric
    Criteria Ratings Points
    Identification of Main Issues, Problems, and Concepts 5 points Distinguished

    Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.

    4 points Excellent

    Identifies and demonstrates an accomplished understanding of most of the issues, problems, and concepts.

    2 points Fair

    Identifies and demonstrates an acceptable understanding of most of the issues, problems, and concepts.

    1 point Poor

    Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts.

    5 points
    Use of Citations, Writing Mechanics and APA Formatting Guidelines 3 points Distinguished

    Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

    2 points Excellent

    Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

    1 point Fair

    Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

    0 point Poor

    Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.

 
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PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS

3). PLEASE SEE THE FOLLOWING ATTACHED RUBRIC DETAILS.

Thank you.

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

  • Review the Healthcare Program/Policy Evaluation      Analysis Template provided in the Resources.
  • Select an existing healthcare program or policy evaluation or choose one of interest to you.
  • Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

  • Describe the healthcare program or policy outcomes.
  • How was the success of the program or policy measured?
  • How many people were reached by the program or policy selected?
  • How much of an impact was realized with the program or policy selected?
  • At what point in program implementation was the program or policy evaluation conducted?
  • What data was used to conduct the program or policy evaluation?
  • What specific information on unintended consequences was identified?
  • What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
  • Did the program or policy meet the original intent and objectives? Why or why not?
  • Would you recommend implementing this program or policy in your place of work? Why or why not?
  • Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

    Rubric Detail

    Select Grid View or List View to change the rubric’s layout.

    Content

    Name: NURS_6050_Module05_Week10_Assignment_Rubric

     

    Excellent Good Fair Poor
    Program/Policy Evaluation Based on the program or policy evaluation you seelcted, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following: ·   Describe the healthcare program or policy outcomes. ·   How was the success of the program or policy measured? ·   How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? ·   At what point in time in program implementation was the program or policy evaluation conducted? Points: Points Range: 32 (32%) – 35 (35%) Response clearly and accurately describes in detail the healthcare program or policy outcomes. Response accurately and thoroughly explains in detail how the success of the program or policy was measured. Response clearly and accurately describes in detail how many people were reached by the program or policy and fully describes the impact of the program or policy. Response clearly and accurately indicates the point at which time the program or policy evaluation was conducted. Feedback: Points: Points Range: 28 (28%) – 31 (31%) Response accurately describes the healthcare program or policy outcomes. Response accurately explains how the success of the program or policy was measured. Response accurately describes how many people were reached by the program or policy and accurately describes the impact of the program or policy. Response accurately indicates the point at which time the program or policy evaluation was conducted. Feedback: Points: Points Range: 25 (25%) – 27 (27%) Description of the healthcare program or policy outcomes is inaccurate or incomplete. Explanation of how the success of the program or policy was measured is inaccurate or incomplete. Description of how many people were reached by the program or policy and the impact is vague or inaccurate. Response vaguely describes the point at which the program or policy evaluation was conducted. Feedback: Points: Points Range: 0 (0%) – 24 (24%) Description of the healthcare program or policy outcomes is inaccurate and incomplete, or is missing. Explanation of how the success of the program or policy was measured is inaccurate and incomplete, or is missing. Description of how many people were reached by the program or policy and the associated impacts is vague and inaccurate, or is missing. Response of the point at which time the program or policy was conducted is missing. Feedback:
    Reporting of Program/Policy Evaluations ·   What data was used to conduct the program or policy evaluation? ·   What specific information on unintended consequences was identified? ·   What stakeholders were identified in the evaluation of the program or policy? Who would benefit the most from the results and reporting of the program or policy evaluation? Be specific and provide examples. ·   Did the program or policy meet the original intent and objectives? Why or why not? ·   Would you recommend implementing this program or policy in your place of work? Why or why not? ·   Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation. Points: Points Range: 45 (45%) – 50 (50%) Response clearly and accurately identifies the data used to conduct the program or policy evaluation. Response clearly and thoroughly explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation. Response clearly and accurately explains in detail the stakeholders involved in the program or policy evaluation. Response clearly and accurately explains in detail who would benefit most from the results and reporting of the program or policy evaluation. Response includes a thorough and accurate explanation of whether the program met the original intent and outcomes, including an accurate and detailed explanation of the reasons supporting why or why not. Response includes a thorough and accurate explanation of whether the program should be implemented, including an accurate and detailed explanation of the reasons supporting why or why not. Feedback: Points: Points Range: 40 (40%) – 44 (44%) Response accurately identifies the data used to conduct the program or policy evaluation. Response explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation. Response explains in detail the stakeholders involved in the program or policy evaluation. Response explains who would benefit most from the results and reporting of the program or policy evaluation. Response includes an accurate explanation of whether the program met the original intent and outcomes, including an accurate explanation of the reasons supporting why or why not. Response includes an accurate explanation of whether the program should be implemented, including an accurate explanation of the reasons supporting why or why not. Feedback: Points: Points Range: 35 (35%) – 39 (39%) Response vaguely or inaccurately identifies the data used to conduct the program or policy evaluation. Explanation of specific information on outcomes and unintended consequences identified through the program or policy evaluation is vague or incomplete. Explanation of the stakeholders involved in the program or policy evaluation is vague or inaccurate. Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague or inaccurate. Explanation of whether the program/policy met the original intent and outcomes and the reasons why or why not is incomplete or inaccurate. Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete or inaccurate. Feedback: Points: Points Range: 0 (0%) – 34 (34%) Identification of the data used to conduct the program or policy evaluation is vague and inaccurate, or is missing. Explanation of specific information on outcomes and unitended consequences identified through the program or policy evaluation is vague and incomplete, or is missing. Explanation of the stakeholders involved in the program or policy evaluation is vague and inaccurate, or is missing. Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague and inaccurate, or is missing. Explanation of whether the program or policy met the original intent and outcomes and the reasons why or why not is incomplete and inaccurate, or is missing. Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete and inaccurate, or is missing. Feedback:
    Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. Points: Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. Feedback: Points: Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive. Feedback: Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Feedback: Points: Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided. Feedback:
    Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation Points: Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Feedback: Points: Points Range: 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. Feedback: Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. Feedback: Points: Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Feedback:
    Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Points: Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors. Feedback: Points: Points Range: 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors. Feedback: Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors. Feedback: Points: Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors. Feedback:

    Show Descriptions Show Feedback

    Program/Policy Evaluation Based on the program or policy evaluation you seelcted, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following: ·   Describe the healthcare program or policy outcomes. ·   How was the success of the program or policy measured? ·   How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? ·   At what point in time in program implementation was the program or policy evaluation conducted?–

    Levels of Achievement: Excellent 32 (32%) – 35 (35%) Response clearly and accurately describes in detail the healthcare program or policy outcomes. Response accurately and thoroughly explains in detail how the success of the program or policy was measured. Response clearly and accurately describes in detail how many people were reached by the program or policy and fully describes the impact of the program or policy. Response clearly and accurately indicates the point at which time the program or policy evaluation was conducted. Good 28 (28%) – 31 (31%) Response accurately describes the healthcare program or policy outcomes. Response accurately explains how the success of the program or policy was measured. Response accurately describes how many people were reached by the program or policy and accurately describes the impact of the program or policy. Response accurately indicates the point at which time the program or policy evaluation was conducted. Fair 25 (25%) – 27 (27%) Description of the healthcare program or policy outcomes is inaccurate or incomplete. Explanation of how the success of the program or policy was measured is inaccurate or incomplete. Description of how many people were reached by the program or policy and the impact is vague or inaccurate. Response vaguely describes the point at which the program or policy evaluation was conducted. Poor 0 (0%) – 24 (24%) Description of the healthcare program or policy outcomes is inaccurate and incomplete, or is missing. Explanation of how the success of the program or policy was measured is inaccurate and incomplete, or is missing. Description of how many people were reached by the program or policy and the associated impacts is vague and inaccurate, or is missing. Response of the point at which time the program or policy was conducted is missing. Feedback:

    Reporting of Program/Policy Evaluations ·   What data was used to conduct the program or policy evaluation? ·   What specific information on unintended consequences was identified? ·   What stakeholders were identified in the evaluation of the program or policy? Who would benefit the most from the results and reporting of the program or policy evaluation? Be specific and provide examples. ·   Did the program or policy meet the original intent and objectives? Why or why not? ·   Would you recommend implementing this program or policy in your place of work? Why or why not? ·   Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.–

    Levels of Achievement: Excellent 45 (45%) – 50 (50%) Response clearly and accurately identifies the data used to conduct the program or policy evaluation. Response clearly and thoroughly explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation. Response clearly and accurately explains in detail the stakeholders involved in the program or policy evaluation. Response clearly and accurately explains in detail who would benefit most from the results and reporting of the program or policy evaluation. Response includes a thorough and accurate explanation of whether the program met the original intent and outcomes, including an accurate and detailed explanation of the reasons supporting why or why not. Response includes a thorough and accurate explanation of whether the program should be implemented, including an accurate and detailed explanation of the reasons supporting why or why not. Good 40 (40%) – 44 (44%) Response accurately identifies the data used to conduct the program or policy evaluation. Response explains in detail specific information on outcomes and unintended consequences identified through the program or policy evaluation. Response explains in detail the stakeholders involved in the program or policy evaluation. Response explains who would benefit most from the results and reporting of the program or policy evaluation. Response includes an accurate explanation of whether the program met the original intent and outcomes, including an accurate explanation of the reasons supporting why or why not. Response includes an accurate explanation of whether the program should be implemented, including an accurate explanation of the reasons supporting why or why not. Fair 35 (35%) – 39 (39%) Response vaguely or inaccurately identifies the data used to conduct the program or policy evaluation. Explanation of specific information on outcomes and unintended consequences identified through the program or policy evaluation is vague or incomplete. Explanation of the stakeholders involved in the program or policy evaluation is vague or inaccurate. Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague or inaccurate. Explanation of whether the program/policy met the original intent and outcomes and the reasons why or why not is incomplete or inaccurate. Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete or inaccurate. Poor 0 (0%) – 34 (34%) Identification of the data used to conduct the program or policy evaluation is vague and inaccurate, or is missing. Explanation of specific information on outcomes and unitended consequences identified through the program or policy evaluation is vague and incomplete, or is missing. Explanation of the stakeholders involved in the program or policy evaluation is vague and inaccurate, or is missing. Explanation of who would benefit most from the results and reporting of the program or policy evaluation is vague and inaccurate, or is missing. Explanation of whether the program or policy met the original intent and outcomes and the reasons why or why not is incomplete and inaccurate, or is missing. Explanation of whether the program or policy should be implemented, and the reasons why or why not, is incomplete and inaccurate, or is missing. Feedback:

    Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–

    Levels of Achievement: Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive. Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided. Feedback:

    Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation–

    Levels of Achievement: Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Good 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Feedback:

    Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–

    Levels of Achievement: Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors. Good 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors. Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors. Feedback:

    Total Points: 100

    Name: NURS_6050_Module05_Week10_Assignment_Rubric

 
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Epstein Barr Virus

 

A pathogen is a biological agent that causes illness or disease to its host. Therefore, Emerging Pathogens or Emerging Infectious Diseases are those which have been discovered recently, within the last 10-30 years.

The World Health Organization (WHO) defines an emerging disease as “one that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range.” This week, we will examine some emerging pathogens and diseases!

You must discuss your chosen human pathogen to tell us what type of microbe it is, what disease it causes, how the disease is emerging, signs & symptoms, course of disease, treatment and prevention.

.

Your  discussion should be well-written, in your own words, paraphrasing from only credible academic sources. You may not directly quote from your sources, minimum elaboration on the topic of a minimum of 300 words and maximum of 400 words.

 

You must also cite your credible academic reference sources with parenthetical in text citations, and provide full end ref information in APA 7th Edition format.

 
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