Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

*******************National Rural Health Association*****************************

 

1) **********minimum 20 slides with speakers notes (cover, objetives or reference slide not included)

******************Should summarize the findings in a 2 pages

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs)

3)********** It will be verified by Turnitin and SafeAssign 

4) References not older than 5 years

5) Each answer must be identified according to the question number. Check the list of questions. 

Your answer should start objectively answering the question

Question:

1)…………

2)…………

3)…………

Answer:

1)…………

2)…………

3)…………

———————————————————————————————————

1)investigate the group’s key issues;

2) what is their mission; 

3) what is their legislative agenda; 

4) how is the agenda developed; 

5) how is it communicated to members; 

6) how is their agenda pushed and promoted (i.e., mechanisms used to engage/attract and influence policy makers); 

7) what are the group’s current lobbying efforts; 

8) key partner coalitions; 

9) do their partnerships influence policies at the local, state or national level; 

10) key obstacles; 

11) spending allocations 

12 *********************Mandatory: consult the Center for Responsible Politics, www.opensecrets.org. 

investigating the interest group’s website:

13) reviewing position statements and testimony

14) should consult media reports and discuss more information on the group’s current lobbying efforts. 

Describe components of a clinical based decision-making model impacted by clinical expertise and explain how clinical expertise informs evidence-based practice.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

Learning Materials Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health. ISBN: 978-1-4511-9094-6. Read Chapters 13 and 14.

 

ENGL 1020: Composition/Analysis    

University of Memphis

Argument Revision Assignment 

I have rewritten — often several times — every word I have ever published. My pencils outlast their erasers.” — Vladimir Nabokov, Speak, Memory, 1966

“I don’t write easily or rapidly. My first draft usually has only a few elements worth keeping. I have to find what those are and build from them and throw out what doesn’t work, or what simply is not alive.” — Susan Sontag

“Put down everything that comes into your head and then you’re a writer. But an author is one who can judge his own stuff’s worth, without pity, and destroy most of it.” — Colette, Casual Chance, 1964

“By the time I am nearing the end of a story, the first part will have been reread and altered and corrected at least one hundred and fifty times. I am suspicious of both facility and speed. Good writing is essentially rewriting. I am positive of this.” — Roald Dahl

“The best advice I can give on this is, once it’s done, to put it away until you can read it with new eyes. Finish the short story, print it out, then put it in a drawer and write other things. When you’re ready, pick it up and read it, as if you’ve never read it before. If there are things you aren’t satisfied with as a reader, go in and fix them as a writer: that’s revision.” — Neil Gaiman

Overview: 

As the above quotes from famous writers explain, successful writers are successful revisers. Writing courses often don’t build in time to allow for revision, leaving the false impression that effective writing can actually happen in a few days or weeks. Thus, your final and major project of this course asks you to take all that you have learned about writing processes, composing, and research in order to revise your researched argument.  You may use writing you produced in your first draft, but if the paper does not change significantly, then your essay grade will be lowered. Your goal for this paper should be to improve your argument and to improve your presentation (tone, sentence structure, organization) of that argument. This paper should be a minimum of eight pages and use a minimum of eight sources (five of which have to be academic/government). 

What is revision? Revision involves making global changes to your writing. It involves deleting, moving, and rewriting large parts (if not all) of your previous drafts. It often means doing new research, finding new ways to discuss your topic, and even starting fresh—only pulling words from your first draft when absolutely necessary (and even then those words might need to change). Revising is not the same as editing and proofreading. Editing and proofreading focus on sentences, words, and correctness. Revision focuses on making meaning and on the overall organization and development of your argument.

This is the culmination of all of our work this term and is worth 35% of the semester grade.

The Process: 

This assignment is going to ask you to complete a number of steps in order to improve your essay.  Create a reverse outline of your argument.  Create a revision plan and meet with your instructor to discuss it.  Do new research. Find new sources to support your argument (the reverse outline should help you identify the type of research you need to do in order to support your claims).  Rewrite and revise!  Edit and proofread. 

Requirements:  Eight to ten full pages (excluding works cited) Must include eight sources, of which five must be academic or government sources  MLA format  Topic related to Memphis (unless you are out of the area, in which case you may argue a topic in your own area.)

Due Dates:  Revision Plan Due end of week #13. Complete additional research and begin rewriting Conferences Week#14—continue researching and writing  Writers Workshop Draft due Thursday of Week #15  Final draft is due Sunday 11:59pm of Week #15

 APA format 3 peer references and response needs to agree or disagree with differential diagnosis and explain why

 

Week 9: Review of case study 1

Patient Initials: _AS__                       Age: __20___                         Gender: __M_

SUBJECTIVE DATA:

Chief Complaint (CC): an Unbearable headache

History of Present Illness (HPI): 20-year-old Caucasian male presented with a chief complaint of intermittent headaches. The patient reports that a headache is so bad and unrelenting that he feels it in his eyes with great intensity, nose, cheekbones, and jaw. The patient states “The headache ache comes and goes.” The patient reported that his headache started two days ago and had increased in severity of a 10/10 on the pain scale as the pressure in the eyes creating the sensitivity to light, the feeling of having toothache makes it too hard to bear. While the patient was not able to pinpoint when his headache started, he reports that he was so overwhelmed with school and work over the past couple of weeks, it may have precipitated the headache.  The patient reporting taking Tylenol which is ineffective; he has tried to get more sleep and use dimmed lights while awake. He states, “while the sleeping for a longer time helps a little, the headaches return as the day progress and gradually gets worse with each passing minute. The only thing that stops the headache is passing time.”.

Medications: Tylenol 650 mg every 4 to 6 hours.

Allergies: Ibuprofen- angioedema

Past Medical History (PMH): Mumps -resolved

Past Surgical History (PSH): Appendectomy at age 16 due to a ruptured appendix.

Sexual/Reproductive History: Not sexually active.

Personal/Social History: Reports going to church on Saturdays (worship sunset to sunset), Saturday after sabbath worship; sometimes going bowling or roller skating and socializes with peers from church or school. Denies tobacco use, alcohol use, and drug use. Patient reports at least three mornings per week approximately one hour of exercise at the work gym.

Immunization History: reports immunization up to date and will get his annual flu shot at work October 25, 2018.

Significant Family History: grandfather died one year ago (72) from heart failure. Grandmother 68 alive and living with hypertension.

Lifestyle: Patient is newly as a mental health counselor at a hospital psychiatric unit. He just started studying law part-time at the local university; current course is online. He currently lives alone in a two-bedroom apartment, as parents live in another country. His support system is his family who is a phone call away, and his best friend who lives 20 minutes away from his home. He does not drink, smoke or do drugs. He attends church on Saturday. Socializes with church friends and or best friend after sunset some Saturday at the local bowling alley, skating rink, or “hang out” at a local diner. Currently is not involved in a relationship and is not sexually active.

Review of Systems:

General: Patient reports having an “unbearable headache” Patient is unaware of any changes in weight, eating preference or activities; however, reports a decrease in appetite.

            HEENT: “except for the increasing headache no problem.”, reports wearing shades due to an increased sensitivity to lights; no hearing impairment; reports stuffy nose in the morning in the morning but no runny nose; denies difficulty chewing or swallowing, pain or discomfort.

 Neck: Endorses stiffness, reports “may be due to tension.”

            Respiratory: denies any respiratory distress

            Cardiovascular: denies palpitation, denies heart problems

            Gastrointestinal: Reports decreased appetite, some nausea, no vomiting no change in bowel pattern noted.

            Genitourinary: No change in urinary function

            Musculoskeletal: Denies problem with range of motion, walking or gait.

            Psychiatric: Denies having any psychiatric history

            Neurological: Reports feeling less alert, unfocused at times.

            Skin: Denies any dermatological problems

OBJECTIVE DATA:

 Physical Exam:

Vital signs: temp: 98.4, b/p 130/74, RR 18, pulse 88, SPO2 100% ht. 5’7” weight 140 BMI 21.9.

General: Patient is an alert and oriented *4, 20-year-old Caucasian male who appears to be in good health. He is appropriately groomed, no odor and looks clean. Erect posture, steady gait. Facial expression looks strained and sad; mood appears dysphoric. He is speaking English fluently and clearly. Voice is low and calm. Speech appear slowed and forced. The patient was able to count from 1-20 backward and repeat a series of words without hesitation. Reports having a headache for a long time, “maybe age 11, really not sure, but they weren’t this awful or frequent.”. For the past four months he has been having headaches for at least four days straight per month; but, this latest bout of headaches has been the worst experienced. He denies any head injury or trauma, and chronic illnesses. Patient report at its worst the pain is 10/10, and at its best, it is 7/10. He also states, “while I take Tylenol, I don’t think it effective; I think time passing makes it goes away, the problem is times seem to go too slow.”.

HEENT: head is symmetrical and normocephalic, no depression, swelling but reported tenderness. Denies head injury or trauma. No facial drooping, Patient endorses headache that is currently a 7/10. Reports pain is to present at forehead bilateral, temporal artery has no bruit, patient reports feeling like a “pressured weight” on his head. Patient does report some pulsating pain with movement. He also endorses feeling the pain behind the eyes, nose, cheekbones and jaw. His forehead is creased. Eyes are symmetrical.  Left eye appears glossy, no crusting, no nicking of arteries, optic disc is reddish orange, no microaneurysm, neovascularization.  Patient states, “pain can be felt in the eyes and vision in the left eyes sometimes vision seems blurred or doubled and funny”. On evaluation the patient can read clearly at 20/20 on the Snellen eye chart. Pupils are equal, rounded, reactive to light and accommodation. Peripheral vision is intact. No excess blinking, denies pain on examination. No wax in the ear, symmetrical, clean, no difficulty hearing bilaterally during whisper, Weber and Rinne test, no infection or lesion noted, the handle of malleus, light reflex, and the umbo is visualized as the membrane is pearly gray. Nose is midline, no stuffiness, no redness, no drainage noted. Lips are pink and moist, no cavities noted, reports last dental exam and cleaning was September 2018. Tongue is light pink and moist, no problem with swallowing, hard and soft palate gag reflex. Tongue is flexible and resistant to force. Salivary glands are functional. No pain reported on examination.

Neck: Good range of motion, lymph nodes are not palpable; however, tension can be felt in the neck, appears as if the patient has difficulty relaxing. The trachea is midline; thyroid is non-palpable.

Chest: No wheezing, rhonchi, or rales

Lungs: clear in all four quadrants

Heart: no murmurs or abnormal heart sound

Abdomen: flat and no tender, bowel sounds present in all four quadrants, no reports of difficulty in bowel movement or change in the pattern

Musculoskeletal: range of motion is good, no curvature noted. No swelling, redness or tenderness. Some stiffness in the neck but not related to the range of motion but to the patient not being able to relax/ patient is tense. No difficulty in standing, walking in a straight line, stopping or turning suddenly. Balance and gait are exceptional. Patient report having frequent muscle contraction.

Psychiatric: While presently dysphoric, no indication of depression on assessment, the patient appears future-oriented. Denies suicidal and homicidal ideation as well as auditory and visual hallucination. Headache complaint does not appear somatic.

Neurological: Cranial nerve assessment finds all nerve intact with no impairment. The patient is alert and oriented to person, place, time and situation. He can do serial addition and multiplication; repeat a series of words after having a different line of conversation. Count from 1-20 backward. No numbness or tingling in fingers, toes, or face. Muscle strength is (5) good as there is active motion against full resistance, reflex is 2+ normal. Patient can recognize writing on skin, interpret hard and soft with eyes closed. While no sensory issue is present patient reports based on the increased level of activity on the unit at the increase stimuli has been affecting his concentration; he feels overstimulated believes he cannot process new information right now, only wanting to concentrate on one task at a time. He also reiterates that bright light bothers his eyes and the combination with the increased stimulants makes the headache worst. Patient reports feeling less alert and unfocused; however, while this may occur, this neurological exam does not correlate.

24 Hour diet and activity recall: – woke 5:30 or work 8-hour work day which begins at 7 am. 10 am, Breakfast 2 boiled eggs, a slice of toast with a slice of cheese, a bowl of cereal and a glass of coffee. Lunch, chicken Caesar salad. No dinner, went straight at 4pm home after work headache was too intense. Slept for 3 hours, headache was still present but less intense, spent 4 hours on school work then went back to sleep, slept until 5:30 am, then got ready for work. Reports drinking on average four to five glasses of water per day. Patient does not cook, will sometimes eat frozen tv dinners or ramen noodles; sometimes snacks heavily, his favorite snacks are chocolate ice-cream, eclairs, Cheetos and Doritos.

Diagnostic test MRI, and or CT-scan, and complete blood count to rule out inflammation.

 ASSESSMENT:

Tension Headache- Per Dains, Baumann & Scheibel, (2016) Tension headache is the most common type of headache in adults, and the pain is bilateral, and last for hours to days, and it can form a cycle that may last for months. The text also notes that factors such as stress, hunger and depression can trigger this headache. Based on information gained from AS, stress is likely a contributing factor to AS headaches. However, results from imaging and testing are needed to determine his type of headache. In a randomized clinical study conducted by Omidi, & Zargar, (2015) they found that the use of psychotherapy dubbed mindfulness-based stress reduction was helpful in reducing pain and stress and would be a useful tool in relieving the tension headache.

Migraine- Per Dains, Baumann & Scheibel, (2016) migraine without aura is seen in 20% of the population, has a unilateral throbbing pain with symptoms of nausea and photophobia. According to Tai, Yap, & Goh, (2018) dietary intake can trigger migraine headaches. They conducted a study that found that coffee, chocolate and monosodium rich foods such as broth, flavored snacks, frozen foods, and pasta sauce can trigger a migraine. It is clear from AS description he is experiencing throbbing pain and is experiencing nausea and photophobia, however, he does states that his headache is bilateral. Hence a leaning towards mixed headache diagnosis. However, this differential diagnosis cannot be ruled out as the patient may also have a migraine with aura as well. In any event, diet change and food choices must be discussed with the patient has some of AS choices is likely a trigger to his headache.

Mixed headache- According to Dains, Baumann, & Scheibel, (2016) is a combination of tension and migraine whereby the effect is a combination of throbbing, tightness, pressure and constant pain is felt.  Based on AS description this may be what he is experiencing, therefore, this is an important differential diagnosis Krøll, Hammarlund, Westergaard, Nielsen, Sloth, Jensen, & Gard, (2017) performed a study on mixed headaches; the writers noted that while this type of headache is common, very little study is done, so there are not many tailored interventions exist to help the patient. Therefore, more studies are needed to help understand mixed headaches and proper medication modalities, and alternative remedies, to help alleviate and manage the pain.

Conclusion

Per Dain, Baumann, & Scheibel, “headache and nausea are associated with head trauma, stroke, and tumor.” While this may true in many cases, headaches do not seem to have a definitive cause and appear to be puzzling as some headaches have no underlying factors and give no warning. As always pain is what the patient says, so determinants are based mostly on the information provided by the patient. Therefore, asking the right questions is very important. Diagnostic tests, lab test, and physical assessment is done to ensure patient body systems; neurological functionalities are not affected as headaches could be secondary, as a result of many other medical issues; such as sinusitis, meningitis, optic neuritis, or a tumor.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Krøll, L. S., Hammarlund, C. S., Westergaard, M. L., Nielsen, T., Sloth, L. B., Jensen, R. H., & Gard, G. (2017). Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The Journal of Headache and Pain, 18(1), 46.

Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences, 20(11), 1058–1063

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

Tai MLS, Yap JF, & Goh CB. (2018). Dietary trigger factors of migraine and tension-type headache in a South East Asian country. Journal of Pain Research, Vol Volume 11, Pp 1255-1261 (2018), 1255