Write a 500-800 word paper discussing the different methodologies and designs used in each study.

Discuss the external and internal validity issues associated with each methodology and design.

1. Provide a brief summary of each article. Cite using APA format, do NOT use full article titles in your writing.
2. Discuss the external and internal validity issues associated with each methodology and design. 
   1. Evaluate the source (i.e. the journal) the article was published in.
   2. Evaluate the sources, type of sources, the quantity of sources, and applicability of sources the authors use. Check the information you are using against another source beyond the reference page to ensure the validity of the research. For example, if the piece includes specific dates or facts, check those dates and facts against a second reliable source. If the facts do not match, there is a good chance the research article is not entirely valid.
   3. Verify the author’s credentials, and co-author’s credentials.
   4. Describe how the authors described the specific details of how the study was designed as well as the overall study components. How did the authors describe the rigor of the study? How did the authors control for extraneous variables?
   5. How did the authors establish the effects of the intervention/treatment? There are several types of internal validity factors to evaluate including experimental mortality, randomization, blinding, adverse effects of placebo administration, and scientific misconduct.
   6. Are there any methodological problems? Do the authors demonstrate statistical significance? Use the same criteria for establishing the effects of treatment to evaluate the methodological problems.
   7. How did the authors establish a case for generalizability? Generalization can be established even if the authors did not use randomization, if this is the case in the articles you chose, describe how the authors evaluated for generalizability.
   8. Describe how using a different methodology or design might have been beneficial for each study and describe why.
3. Summarize your entire paper.

 WK3/M

“Gaming is an instructional method requiring the learner to participate in a competitive activity with preset rules (Allery, 2004). The goal is for the learners to win a game by applying knowledge and rehearsing skills previously learned” (Bastable, S.B., 2014, p.486). Gaming has been proven to stimulate the learning environment and its particularly attractive o children.

        Gaming has been the selected instructional method chosen to teach a class of 10 Hispanic adolescents whose first language is Spanish. This small group of adolescent will taught about healthy lifestyle and healthy meal choices. Acculturation will be discussed and students will be allowed to express their feelings. Important key factors and characteristics of this ethnic group will be taken into account in order to develop a successful teaching plan which will be through the gaming strategy. Culturally acquired living styles will be respected and share through the game. Preferred language will be assessed and the ability to effectively communicate in English will also be taken into account. Written and audiovisual materials will also be available for further reference and clarification. (Bastable, S.B., 2014). The setting will be a classroom which will be equipped with a screen, laptop, screen projector and handouts with the information and the rules for the game. The class will be divided into two groups. Each group will be presented with a picture of a meal and they will need to identified as healthy or unhealthy and specify why. The group that gives the best explanation will win 1 point. Each group will also be responsible for developing a weekly exercise plan according to their age and the most complete plan will be the winner. At the end of the game the winner group will be recognized and will be allowed to do small presentation about what they learned through the game.

        The pictures to be presented will closely relate to this specific ethnic group meal choices and by discussing what it is health or not substitutes for the ingredients or meals will also be presented. The objectives of this game is to exchange unhealthy eating habits by healthy ones while maintaining their meal preferences based on their culture and choices. Understanding the benefits of daily exercise to one’s health will also be another objective that will be evaluated through the teach- back method.

        Gaming is a great teaching strategy that has been known for keeping the learner’s attention throughout the session. It is suitable for all development levels of the learner, all ethnic groups and can take place anywhere with little resources needed. Gaming may improve recall and retention of information and learner will learn while having fun. (Bastable, S.B., 2014).

Comment 1

The Center for Medicare and Medicaid (CMS) reimbursement rules establish payment rules related to health conditions happening during the hospital stay that are not present upon admission. These conditions are generally known under the terms “never events” (Stone, W., P.; Glied, A., S.; McNair, D.,P.; Matthes, N.; Cohen, B., Landers, F.; T.; & Larson, L., E.

 (2010).  

                 This policy addresses preventable health conditions such as infections, inpatient morbidity and mortality. Regulations resulting from CMS policy reject payment for the previously mentioned conditions.

The particularity of this policy is that it brings a shift in the patient care delivery model in inpatient facilities. Notably, physicians, healthcare management, and other inpatients interested parties carry the risk of becoming liable of any person providing inpatient care. With liability risk for inpatient care delivery, physicians are become more careful while they are performing any types of medical interventions on patients. They are compelled to be attentive in monitoring patients’ health conditions.

The innovative and intended goal of this shift is to improve the quality of care received during a hospital stay. Particularly, CMS policy is targeted at averting hospital-acquired conditions 

Comment 2

Never Events as termed by the Center for Medicare and Medicaid Services (CMS), are complications that are “preventable by following evidence-based guidelines and thus CMS no longer reimburses for medical services rendered to treat them” (O’Rourke & Hershey, 2009). These are injuries or illnesses, 28 in all, that could have been prevented if the hospital had taken proper prevention, some examples are catheter associated infections, air emboli, falls, and pressure ulcers. When these types of injuries occur, the burden is now on the health care provider to prove they occurred in absence of negligence. Health care providers must know and follow the evidence base protocols when it comes to these ‘Never Events’ to prevent them and get reimbursed. Private health insurance companies are also following CMS and notifying hospitals about not paying for hospital mistakes. To counter act these ‘Never Events’ patients may experience more testing before admission to hospitals to prove they did or did not have any infection prior to. Or “infected patient may be discharge too soon to only come back with the infection and then CMS has to pay for the newly admitted patient that arrived with an infection” (Torrey, 2018). So, basically these ‘Never Event’ still mean cost are passed on to the patients. Either by treatment prices going up that are passed on to the patient or by not being ‘cured’ prior to discharge only to come back again and now being billed for that infection. Even though the ‘Never Events’ was design to protect the patient from certain consequences it definitely produced other consequences like cost and sometimes death.

Comment 3

The Centers for Medicare and Medicaid Services (CMS) adopted the non-reimbursement policy for certain hospital acquired conditions or occurrences which have been deemed as never events by explaining that these events are reasonably preventable through evidence based practice (Lembitz & Clarke, 2009). The Centers for Disease Control (CDC) estimated costs of healthcare-associated infections in U.S. hospitals to be between $28 and $45 billion per year with the top three leading causes being pressure ulcers, postop infections and mechanical complication if a device such as graft (Preventing Never, 2011). Such non-reimbursable events are used to motivate hospitals to make changes to better care for patients by implementing standardized protocols (Lembitz & Clarke, 2009). Also, such events deemed reasonably preventable by provided adequate care limit the ability for hospitals to bill Medicare for adverse events and complications (Lembitz & Clarke, 2009). Such events include wrong surgery on patient or wrong site, death or disability due to incompatible blood products, pressure ulcers post admission, fall within the facility and well as hospital acquired infections such as CAUTI, surgical site infection post CABG or bariatric surgery or orthopedic surgery as well as post knee or hip replacement surgery DVT or PE (Lembitz & Clarke, 2009).  Hospitals are implementing protocols to encourage staff to assist in preventing never events therefore preventing non-reimbursement events (Lembitz & Clarke, 2009). These include identifying fall risks and labeling the patients appropriately so all staff are aware, double nurse checks on blood administration, time-outs taken in surgery and reducing hospital acquired infections by using evidence based practice guidelines (Lembitz & Clarke, 2009). Another factor that can affect avoiding never events is adding one staff RN to the nurse-to-patient ratio. One additional patient per RN per shift was associated with increased risk of: failure to rescue cases (7% increase), hospital acquired pneumonia (7% increase), pulmonary failure (53% increase), unplanned extubation (45% increase), medical complications (17% increase) (Preventing Never, 2011).

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?