Case Study 3

Kevin worked for 10 years at a uranium mine, excavating uranium for a nearby nuclear power plant. Now, 25 years later, he has small cell lung cancer. Kevin is anorexic and has lost a considerable amount of weight. His muscles are wasting, and he is weak. He tries to move around the house throughout the day but tires easily. It has been difficult for him to access care, and the treatment for his cancer is just starting.

1. With the ongoing exposure to the ionizing radiation, DNA damage occurred. Outline the three stages of carcinogenesis that occurred after his exposure to radiation.

2. Kevin is normally a fit and active man, and his wife often commented on how much food he used to eat after a day at mine. Why would there be muscle wasting and weight loss now? Explain your answer using your 

3. knowledge of the metabolic changes seen with cancer.

In some cancer patients, muscle weakness may result from the production of onconeural antigens. Describe the effects of these antigens. What form would this process likely take in Kevin’s situation?

Case Study Posting Requirements

1. Make sure all of the topics in the case study have been addressed.

2. Cite at least three sources; journal articles, textbooks, or evidenced-based websites to support the content.

3. All sources must be within five years.

4. Do not use .com, Wikipedia, or up-to-date, etc., for your sources.

4 pages not including title page and reference page.

                                  I need this project completed in 4-5 hours

Description: 

Reflect on the research articles you have reviewed to date that relate to your clinical question. Please refer to all the unit resources (e.g., readings, recordings, announcements, etc.) to facilitate this process. With these thoughts in mind, post your thoughts on the following:

1. In the articles you have reviewed, what statistical tests are being used for data analysis?
2. Are the statistical tests being used appropriately for the type of data being produced and the question being asked?
3. Do the authors appropriately indicate implications of the data analysis, or do they overstretch?

In the articles that have I reviewed listed below, I need to know what statistical tests are being used for data analysis?

· A key study for my PICOT project is titled “How Accurate are Self-Reports? An Analysis of Self-Reported Healthcare Utilization and Absence When Compared to Administrative Data” (Koerner & Zhang, 2017).  The authors evaluated the data using Pearson’s correlation and multivariate logistic regression models. 

·  Correlation is a statistical method used to assess a possible linear association between two continuous variables, while Pearson’s correlation coefficient is a test statistics measuring the statistical relationship, or association, between two continuous variables (Mahan, Clark, Anderson, Koller, & Gates, 2017).. Pearson’s correlation coefficient (r) is a measure of the strength of the association between the two variables; it is the best method of measuring the association between variables of interest because it is based on the method of covariance, and covariance is a measure of the joint variability of two random variables (Koerner et al., 2017). If the data is normally distributed, in other words, bell-shaped, and symmetrical about the mean, tests such as the histogram, and normality tests may be used to evaluate if the distribution is normal (McCrum-Gardner, 2008). 

· Are the statistical tests being used appropriately for the type of data being produced and the question being asked?

· The majority of studies may be evaluated with the proper evaluation of over 100 statistical tests to choose from. Tests are chosen depending on the type of research questions being asked, the type of data being analyzed, and the number of data sets or groups being evaluated.

· The first question to be asked is what scale of measurement the data will be, nominal, ordinal, or interval. The study in question involves interval data. The second question is the reason for the analysis; as an example, paired groups or independent groups? 

· Yes, the statistical tests are appropriate for the type of data being produced, and for the type of questions being asked.

· Do the authors appropriately indicate implications of the data analysis, or do they overstretch? 

· Based on our readings and videos, I saw no evidence of data-stretching. For example, data was collected over two calendar years, a lengthy, non-selective inclusion period. A potential confounding factor was that all participants had to have been enrolled in the company health insurance program a minimum of 320 days as a condition of inclusion in the study. Another potential confounding factor was that only hourly employees were included in the two-year study. In addition, pregnant employees were excluded from the study, as these employees are atypical of the general employee population in that their healthcare utilization would be temporarily altered. These factors may have influenced the results, by excluding participants with different reporting habits. After recognizing these potential limitations, their findings mirrored multiple studies previously conducted. 

· The authors also noted potential improvements for future studies, including inclusion of a more diverse employee population, and examining why there exists a difference in self-reporting based on participant sex.

                                                                          References

· Koerner, T. K., & Zhang, Y. (2017). Application of linear mixed-effects models in human neuroscience research: A comparison with pearson correlation in two auditory electrophysiology studies. Brain Sciences, 7(3), page 26. doi:http://dx.doi.org.prx-usa.lirn.net/10.3390/brainsci7030026

· Mahan, K.R., Clark, J.A., Anderson, K.D., Koller, N.J., & Gates, B. J. (2017). Development of a tool to identify problems related to medication adherence in home healthcare patients. Home Healthcare Now, 277-82. doi: 10.1097/nhh.0000000000000539

· McCrum-Gardner, E. (2008).  Which is the correct statistical test to use? British Journal of Oral and Maxillofacial Surgery 46 (2008) 38–41 

· Short, M., Goetzel, R., Pei, X., Tabrizi, M., Ozminkowski, R., Gibson, T., & … Wilson, M. (2009). How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. Journal of Occupational & Environmental Medicine, 51(7), 786-796. doi:10.1097/JOM.0b013e3181a86671

Collapse

Top of Form

Types of Statistical use

           There were six articles retrieved on my PICOT question, (3) were quantitative research, (1) is a mixed method, (2) qualitative research, and (1 )integrative review. The (3) quantitative research were critically appraised and used the following statistical analysis; central standard tendency (mean, median, mode), a probability value to test the significance of results, binomial regression, and binomial distribution, chi-square test, Fisher’s exact test, and measures of standard deviation. Lastly, a study about changing Intensive Care Unit (ICU) culture to reduce CAUTI the research study used statistical process control charts to see the process of improvement in the reduction of catheter-associated infection post-implementation (Maxwell, Murphy and McGettigan, 2018). 

Appropriateness of the statistical test 

The purpose or hypothesis of the study is in the introduction of each literature. The research question aims to evaluate the effectiveness of the CAUTI bundle in the pediatric intensive care unit and adult intensive care unit. To provide patient safety, the use of an appropriate statistical tool in research is essential. According to McCrum-Gardner (2007), using the right scale of measurement will convey accurate results in research.  One research study use sample size is 390 (nominal) children ages from 1 month to 18 years old and admitted in the ICU for 48 hours that needed foley catheter insertion. The exclusions are positive urine culture and less than 48 hours of ICU admission. In addition, the Categorial variable is analyzed using X2 or Fisher exact test. The prevalence rate was calculated using the number of disease within the specified time over the population under risk x 100. The research study shows Foley catheter utilization was calculated by dividing the total number of device days by the total number of patient days (Sönmez Düzkaya, Bozkurt, Uysal, and Yakut,2016). Moreover, the three quantitative research use an appropriate tool and results show that daily CAUTI BUNDLE implementation and changing ICU culture regarding the standard practice showed a significant reduction of catheter-associated urinary tract infection in pediatric ICU and adult ICU.

Conclusion

           The implication of the research study indicates that prevention of CAUTI with the use of CAUTI bundle checklist and application of process improvement had a significant impact on the decreasing morbidity, mortality and healthcare cost. Also, the length of study allowed the researchers to see a significant, consistent change in the reduction of CAUTI.  

References

Maxwell,M.,Murphy, K., and McGettigan, M. (2018)Changing ICU culture to reduce catheter-associated urinary tract infections. Canadian Journal of Infection Control,33 (1) ,39-43 . Retrieved from https://ipac-                   canada.org/photos/custom/pdf/Marcia%20Maxwell_Spring2018.pdf

McCrum-Gardner, E. (2007). Which is the correct statistical test to use?British Journal of Oral and Maxiofacial Surgery, 46, 38-41. Retrieved from https://class.esa.edu/bbcswebdav/institution/USA1/201830/MSN/IPE_7050/readings/McCrumGardner_Which_is the_correct_ statistical_test_to_use_pdf        

Sönmez Düzkaya, D., Bozkurt, G., Uysal, G., & Yakut, T. (2016). The effects of bundles  on catheter-associated urinary tract infections in the pediatric intensive care unit.Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 30(6),341-346. doi:10.1097/NUR.0000000000000246

Bottom of Form

One of the pivotal goals of consumer health literacy efforts is to design educational materials that attract as well as educate users. In this Assignment, you design a health information document on a topic that is of interest to you.

To prepare:

Select a health issue of interest to you.

Identify the audience or population that you seek to educate about this issue.

Search the Internet to find credible sites containing information about your selected topic.

Review the two health literacy websites listed in this week’s Learning Resources. Focus on strategies for presenting information.

To complete:

Design an educational handout on the health issue you selected.

Include a cover page.

Include an introduction that provides:

An explanation of your issue and why you selected it

A description of the audience you are addressing

In the handout itself:

Develop your handout in such a way that it attracts the attention of the intended audience.

Include a description of the health issue and additional content that will enhance your message (i.e., key terms and definitions, graphics, illustrations, etc.).

Recommend four or five sites that provide clear, valuable, and reliable information on the topic.

NEEDED BY 11/21/2017     

View the “Patient Protection and Affordable Care Act” video:       (http://lc.gcumedia.com/zwebassets/courseMaterialPages/nur508_healthcare-reform-video-series-v1.1.php)       

This video was developed just as the 

(commonly referred to as ACA) was due to be implemented. Now that the ACA is operational, contrast the information from the video with actual outcomes and provide your assessment of whether or not the stated goals of the ACA are being met for direct patient care. Support your position using sources inclusive of peer-reviewed literature as well as governmental statistics (state or national) or other nonpartisan resources.     

– use 2 apa references  – answer gquestions straight to the point

– PLEASE NOTE THAT A COVER PAGE IS NOT NEED – THIS IS JUST A DISCUSSION QUESTION. NOTHING FANCY 

Discussion: Developing a Balanced Scorecard

 

How does a group gauge whether the strategic changes they implement are creating sound business results?

 

The effective use of a balanced scorecard can facilitate alignment between strategic initiatives and day-to-day operations. The balanced scorecard may serve as a valuable tool for monitoring progress and assessing the outcomes of a strategic plan and provide a practical means of communication.

 

In this Discussion, you examine the use of a balanced scorecard to measure performance related to finances, customer/client satisfaction, internal processes, and learning and growth.

 

To prepare:

 

Review the information in the Learning Resources, including this week’s media presentation, focusing on the development of performance metrics for a strategic plan. See Figure 8-6: Design your Balanced Scorecard in the Sare and Ogilvie course text.

With your Course Project in mind, think about how you would develop a balanced scorecard to measure performance, including the processes you would use to gather appropriate data.

Consider how the use of a balanced scorecard reflects the importance of being able to evaluate progress, assess the impact of planned change on performance, and determine if the costs are justified in terms of the outcomes.

 

Post an explanation of your plan for creating a balanced scorecard as part of your Course Project, including the processes you would use to gather data to measure performance. Explain how the use of this balanced scorecard would enable you to evaluate progress, assess the impact of your proposed change, and determine if the costs are justified in terms of the outcomes.

 

Read a selection of your colleagues’ responses. (I will send the peer responses on the handshake private message)

 

Respond to at least two of your colleagues on two different days by offering suggestions for further developing their balanced scorecards. Ask questions to peer responses at the end of every response. Cite your responses.

 

Required Readings

 

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Chapter 8, “Overview of Strategic Planning Theories: Strategic Planning Architecture” (pp. 147–166)

 Fields, S. A., & Cohen, D. (2011). Performance enhancement using a balanced scorecard in a patient-centered medical home. Family Medicine, 43(10), 735–739.

Copyright 2011 by Society of Teachers of Family Medicine. Reprinted by permission of Society of Teachers of Family Medicine via the Copyright Clearance Center.

 

The authors discuss using a balanced scorecard for quality improvement in patient-centered medical homes.

 Groene, O., Brandt, E., Schmidt, W., & Moeller, J. (Aug 2009). The balanced scorecard of acute settings: Development process, definition of 20 strategic objectives and implementation.International Journal for Quality in Health Care, 21(4), 259–271.

Copyright 2009 by Oxford University Press – Journals. Reprinted by permission of Oxford University Press – Journals via the Copyright Clearance Center.

 

In this article, the authors discuss the use of a balanced scorecard as a tool for strategic planning in hospitals. The article includes an example of a strategy map, timeline, and balanced scorecard.

 Jeffs, L., Merkley, J., Richardson, S., Eli, J., & McAllister, M. (2011). Using a nursing balanced scorecard approach to measure and optimize nursing performance. Nursing Leadership, 24(1), 47–58.

Copyright 2011 by Longwoods Publishing Corporation. Reprinted by permission of Longwoods Publishing Corporation via the Copyright Clearance Center.

 Kollberg, B., & Elg, M. (2011). The practice of the balanced scorecard in health care services.International Journal of Productivity and Performance Management, 60(5), 427–445.

Retrieved from the Walden Library databases.

 

The authors look at the use of a balanced scorecard for health care performance management in Sweden.

Lupi, S., Verzola, A., Carandina, G., Salani, M., Antonioli, P., & Gregorio, P. (2011). Multidimensional evaluation of performance with experimental application of balanced scorecard: A two year experience. Cost Effectiveness and Resource Allocation, 9(1), 7.

Retrieved from the Walden Library databases.

 

This article examines the application of a balanced scorecard within a unit in a hospital to compare performance results and goal achievement.

 Balanced Scorecard Institute. (2013). Balanced scorecard basics. Retrieved fromhttp://www.balancedscorecard.org/BSCResources/AbouttheBalancedScorecard/tabid/55/Default.aspx

 

View the information on this website to learn about balanced scorecards.

 Mountain State Group. (n.d.) Balanced scorecards for small rural hospitals: Concept overview and implementation guidance. Retrieved March 13, 2013, fromhttp://www.ruralcenter.org/sites/default/files/Final%20BSC%20Manual%2010.18F.pdf

 The Scarborough Hospital. (2013). Balanced scorecard. Retrieved fromhttp://tsh.to/pages/Balanced-Score-Card

 

This website provides an example of a balanced scorecard.

 Sunnybrook Health Sciences Centre. (2013). Balanced scorecard. Retrieved fromhttp://sunnybrook.ca/scorecard/index.asp#sr

 

This website provides an example of a balanced scorecard.

Required Media

Laureate Education (Producer). (2013a). The balanced scorecard approach [Video file]. Retrieved from the https://class.waldenu.edu

 

Note:  The approximate length of this media piece is 3 minutes.

 

Dr. Carol Huston discusses the elements and use of a balanced scorecard as a strategic planning evaluation tool.