Feb 23, 2024 NR 503 Week 3 Discussion Week 3: Discussion- Current Event
NR 503 Week 3 Discussion Week 3: Discussion- Current Event
NR 503 Week 3 Discussion Week 3: Discussion- Current Event
Zaire ebolavirus is a filovirus with five subspecies (Bundibugyo, Zaire, Restone, Tai Forest, and Sudan) with a case fatality ratio of 25-90% (Barry et al, 2018). It is transmitted through contact with the body fluids of infected patients (CDC, 2018). The way of stopping the transmission is by patient isolation and care, early diagnosis, infection control, rigorous tracking of contacts, and the use of targeted vaccination.
On May 3, 2018, the Ministry of Health of the Democratic Republic of the Congo was notified from the Health Division of Equateur Providence that 40 cases of fever (95%) with gastrointestinal symptoms, general fatigue (37 [90%] cases), loss of appetite (37 [90%]), and hemorrhagic signs (14 [33%] people) were occurred including 17 deaths due to possible Ebola virus (Barry et al, 2018). These data were collected by health professionals attending to cases and field investigators. On May 8, 2018, the Democratic Republic of the Congo reported 50 cases (13 probable, 37 confirmed) of Ebola virus disease in Equateur Province where is connected to the capital city (Barry et al, 2018). In order to confirm the cases, detection of Ebola virus RNA in body fluids or blood by reverse transcription PCR was required and used. Since the affected area is concentrated with high population, this outbreak is the highest and complex risk ever experienced by the Democratic Republic of the Congo. On May 20, 2018, 25 deaths from Ebola virus disease had been reported (Barry et al, 2018). In addition, they also reported that 1,458 contacts had been reported and addition 78 cases were confirmed, assuming heterogeneous transmissibility (Barry et al, 2018). The median age of people with probable or confirmed infection was 40 years and usually male (30 [60%]) (Barry et al, 2018).
The design of the study is an epidemiological study with the case-controlled group since it studied people that have already contracted the disease. This study also reviewed published epidemiological evidence about clinical characteristics of Ebola virus disease and contrasted the results of past outbreaks. The aim of this study was to investigate and control the current Ebola virus disease outbreak in the Democratic Republic of the Congo. The results showed that the epidemiological characteristics and features of this outbreak in the Democratic Republic of the Congo, such as signs and symptoms of cases were consistent with previous outbreaks of Ebola virus disease in West Africa(Barry et al, 2018). It also reported that the most common exposures were caused by contact with infected people and participation in traditional burial rites for those who have died from this disease. The source of this outbreak is unknown; however, it’s possible that a new chain of transmission could occur after sexual contact with a male survivor (CDC, 2018). In addition, the case fatality ratio was higher than when this outbreak occurred in West Africa from 2014 to 2016 (Barry et al, 2018). Since West Africa has greater access to Ebola treatment, the case fatality ratio was decreased. The article concluded the study with the importance of safe and dignified burials, community engagement, early detection, and implementation of Ebola treatment along with vaccination for outbreak control (Barry et al, 2018).
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As the reader, I believe that this article was informative and written thoroughly with analytical data and literature reviews. The average reader would find this information useful since it’s easy to understand and follow without a lot of medical terminologies. The article is also reliable and credible by showing the author’s information on the article. The writer also believes that the article didn’t leave out any important information. The article will influence when the Ministry of Health of the Democratic Republic of the Congo reinforces the implementation of Ebola treatment and vaccination at community clinics, local hospitals, and public health centers since the study results show high mortality and fatality rate of Ebola virus disease.
Barry, Ahmadou et al. (2018). Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May 2018: An epidemiological study. The Lancet, 392 (2) 213-221, doi.org/10.1016/S0140-6736(18)31387-4
The Centers for Disease Control and Prevention (CDC). (2018). 2018 Democratic Republic of the Congo, Bikoro. Retrieved from https://www.cdc.gov/vhf/ebola/outbreaks/drc/2018-may.html
A 2005 study published in Nature and directed by Eric Leroy tested more than 1,000 small vertebrates in central Africa and found evidence of asymptomatic Ebola infection in three species of frugivorous bats, which led him to believe that perhaps these animals that sometimes they hunt to consume their meat, were the reservoir of the virus (Kupferschmidt, 2017). Humans can become infected by hunting and eating infected meat or by direct contact with bats. Once infected, the human can transmit the virus to others. Moreover, Ebola has an incredible ability to take over the body fluids of men who have survived the disease long after they have healed. In fact, one study found that more than half of men who survived the West African epidemic tested positive for Ebola in semen a year or more after recovery (CDC, 2016). In one case, the analysis yielded a positive result no less than 565 days after the cure (CDC, 2016). Because of the risk of the disease spreading, survivors are advised to avoid having unprotected sex until their semen has twice tested negative for the presence of the virus. It is estimated that each infected person infects an average of two other people (Doucleff, 2014). The bodies of deceased people remain highly infectious for about seven days. Although Ebola has often been classified as a hemorrhagic fever, WHO and other experts begin to avoid the term as not all individuals present with visible hemorrhages (WHO, 2014). In fact, the evolution is as follows: the first symptoms (tiredness, nausea, fever, headache) are similar to those of diseases such as influenza and malaria, which makes early diagnosis difficult. As the infection progresses, muscle aches, fever and headache become more pronounced and diarrhea and vomiting appear. Often, there is bleeding from the nose or gums. Death occurs within two weeks after the onset of the first symptoms (WHO, 2014).
The rVSV-ZEBOV vaccine, specific for the Zaire strain and not yet approved, was developed by the National Microbiology Laboratory of Canada, tested in Guinea and Sierra Leone during the 2014-2016 epidemic and then purchased by the company. Pharmaceutical Merck, which holds the rights. 100% of the people vaccinated did not develop the disease. However, it was the end of the outbreak and the actual efficacy of this compound must still be proven (Medaglini & Siegrist, 2017). The first trials with the candidate vaccines show that they are safe and that they induce an immune response. What is not yet known is the level of protection and the duration of it. Even if the vaccines do not confer lasting protection, they can be used in future outbreaks to protect the most exposed populations (health workers, among others). Moreover, there is currently no approve vaccine or specific treatments for Ebola. For now, the most effective way to limit in part the mortality caused by the virus is to provide intensive support care, which consists in restoring liquids and electrolytes lost by diarrhea and vomiting.
CDC (2016). Virus Linger Longer than Expected in Semen. Retrieved on July 8, 2018 from https://www.cdc.gov/media/releases/2016/p0830-ebola-virus-semen.html
Doucleff, M. (2014). No, Seriously, How Contagious Is Ebola?. Public Health. Retrieved on July 12, 2018 from https://www.npr.org/sections/health-shots/2014/10/02/352983774/no-seriously-how-contagious-is-ebola
Kupferschmidt, K. (2017).Hunting for Ebola among the bats of the Congo. Since AAAS. (361)6398. doi:10.1126/science. Aan6907
WHO (2014). Ebola Response Team. Ebola virus disease in West Africa — the first 9 months of the epidemic and forward projections. N Engl J Med.371:1481-1495
As future APNs, you will need to be able to identify best practices, which will include evaluating and incorporating published research into your practice.
I’ve listed below some guidelines that you may find useful when critiquing research studies.
Article Title
Is the title concisely stated?
Does the title convey the content of the study?
I. Introduction
A. Statement of the Problem
Is the problem significant?Is the problem clearly and completely formulated?Is the general scope of the study adequately presented?
Is the purpose of the study precisely stated?
B. Related Research
Is previous research related to the study presented?Is the cited research relevant to the study presented?
Is a succinct and meaningful summary presented?
C. Hypotheses or Questions
Are the hypotheses to be tested or the questions to be answered clearly stated?
D. Assumptions and Delimitations
Are the assumptions underlying the study made explicit?
Are these assumptions reasonable?
E. Operational Definitions
Are essential concepts or terms clearly defined or explained?
Are the definitions or explanations meaningful?
II. Method
A. Population and Sample
Are the characteristics of the selected population and sample (size, source, nature, etc.) fully presented?
Is the sampling method indicated?
B. Research, Instruments and/or Apparatus
Are the techniques employed (e.g. interview, questionnaire, apparatus, tests, etc.) clearly and fully described? Are the instruments or techniques appropriate for collecting the data?
If tests were used, what evidence is presented regarding their rationale, reliability, and validity?
C. Procedure
Is the design or procedure clearly and fully reported?Are appropriate statistical methods used in analyzing the data?
Can the study be replicated?
III. Results and Conclusions
Are the findings intelligibly reported in textual presentation?Are the conclusions logically drawn (i.e. based on the data presented)?
Are tables and figures used appropriately?
IV. Discussion
Are the findings discussed adequately and meaningfully?Does the investigator indicate the possible implications of the study?Are these implications meaningful?Are limitations of the study recognized?What are some other limitations that were not mentioned?Are any suggestions offered regarding avenues for further research?
Are these suggestions worthwhile?
V. Summary
Are the problem and methodology restated?
Are the major findings, generalizations, implications, and limitations succinctly
synthesized?
Communication
Is the report well organized?
Is the report well written?
Here’s a link to a good guidance document for critiquing research-
http://www.flinders.edu.au/slc_files/Documents/Blue%20Guides/Critiquing%20Research%20Articles.pdf Links to an external site.
The Center for Disease Control and Prevention (CDC) lists current outbreaks in the US and Internationally. Contamination of food during processing is prevalent in the US currently where Ebola continues to be a problem in Africa and Measles and Yellow Fever Continue to affect some areas around the world (CDC, 2018). One issue also currently being monitored is Zika virus.
A study from the Morbidity and Mortality Weekly Report (MMWR) seeks to properly attribute birth defects to Zika. In the real world, birth defects exist. They can be for a variety of reasons, not all are clear. Cragan et al (2017) examined 774 pregnancies with evidence of birth defects at various stages of gestation to determine if they are attributed to Zika. Cragan et al (2017) examines the severity of fetal defects based on stage and mode of Zika exposure to mother. Although Zika is transmitted by mosquitoes, the effects can vary determining on gestational stage, if father is infected at the time of conception(CDC, 2018). The study frequently references the CDC for information regarding parameters for testing. The live virus is only in the system 2-7 days, but its effects can last for weeks. Antibody and RNA testing is not indicated unless there is birth defect evidence and there is high risk potential in exposure of other or father which almost always refers to travel (Cragan et al, 2017). The average reader would understand that there is no cure for Zika and that travel advisories are most crucial.
Cragan, J. D., Mai, C. T., Petersen, E. E., Liberman, R. F., Forestieri, N. E., Stevens, A. C., & … Meaney-Delman, D. M. (2017). Baseline Prevalence of Birth Defects Associated with Congenital Zika Virus Infection – Massachusetts, North Carolina, and Atlanta, Georgia, 2013-2014. MMWR: Morbidity & Mortality Weekly Report, 66(8), 219-222. doi:10.15585/mmwr.mm6608a4
Centers for Disease Control and Prevention. (July 5, 2018). Zika Virus. Retrieved from https://www.cdc.gov/zika/index.htmlLinks to an external site.
In my introduction of myself in week one, I mentioned that I enjoyed going outdoors, doing stuff like hiking and camping. It is usually my husband, myself, and our dogs. One thing I always worry about is tics and Lyme disease. I live in Indiana and the CDC has shown a rise in Lyme disease cases from 26 in 2006 to 127 confirmed cases in 2016 (Lyme disease data tables, 2017). When I saw the increase in numbers I decided to research on the current information regarding Lyme disease. I was able to find a research article that was published June 11, 2018.
The objective of the study was to determine if early medical intervention would improve complications of infection compared to delayed medical treatment (Hirsch, et al., 2018). This study used a qualitative study that conducted interview with 26 participants and found that there was a lack in education from both population and healthcare providers (Hirsch, et al., 2018). Of the 26 interviewed, ten stated they sought care at the start of symptoms and 7 of the 26 stated they were missed diagnosed by the medical provided that provided their initial assessment (Hirsch, et al., 2018). The researchers did not ask specifics of how the delay in treatment effected the participants but many did voice that it affected their ability to work and manage household responsibilities (Hirsch, et al., 2018).
I think, for the average reader the information in this research article does not provide much help. The article’s objective was to determine if there is an improvement in medical outcome by seeking medical treatment earlier; however, they failed to mention the complications or even determine them. They article states there is a lack in education but, again, failed to offer any education. With the general information given in this article it may cause the average person to do a little more research on their own, or even prompted them to question their PCP about general symptoms.
Early symptoms of Lyme disease fever, chills, joint pain and swelling, and a rash, which can be said of many different infection and easy to misdiagnosis (Signs and symptoms of untreated lyme disease, 2016). I don’t think that this information given will influence any of my decision making in my clinical practice, as there is not a huge population in my area that are at risk. However, it does make me think about educating myself more and look at more ways of prevention.
References
Hirsch, A. G., Herman, R. J., Rebman, A., Moon, K. A., Aucott, J., Heaney, C., & Schwartz, B. S. (2018). Obstacles to diagnosis and treatment of lyme disease in the usa: a Qualitative study. BMJ Open, 8(6), 1-7.
https://bmjopen.bmj.com/content/8/6/e021367Links to an external site.
Lyme disease data tables. (2017, November 1). Retrieved from CDC: https://www.cdc.gov/lyme/stats/tables.html
Signs and symptoms of untreated lyme disease. (2016, October 26). Retrieved from CDC: https://www.cdc.gov/lyme/signs_symptoms/index.html
During this week’s lesson, I was able to learn more about epidemiological research. Specifically, I am now able to understand key components and designs within epidemiological research such as case control designs, cohort designs, association, causation, and relative risk. Understanding these key elements will be foundational for future advanced practice nurses (APNs) as they distinguish creditable research. The two most widely used research design methods are case control and cohort design studies. Both studies seek to test assumption to find the correlation between a risk factor and a disease. A case-control study design begins with the disease prominence and associates risk factors amongst diseased (cases) and not diseased (controls) groups. Through this an odds ratio is produced and associates the ratios of individuals with the intervention between two groups being studied. On the other hand, the cohort design begins studying at contact to the risk factors and relates the incidence of the variable (sickness) in those that have been exposed to it and those in the groups that have not (control) (Aamir, 2016).
Next, association aids in developing a connection between variables. Causation suggests that contact with a variable produces causation of another variable or the disease. Interpreting variables and determining whether or not one causes another is key to determining causation in research. Austin Bradford Hill’s ‘aspects of causation’ can help form a list of components to help in this determination of causation: time, space, and form. By answering these, it can help validate causation and eliminate other types of association (Evans, Lucas, & Kerry, 2016).
Lastly, given the trivia question this week, relative risk (RR) is a ratio that compares two populations. Population A divided by population B equals the RR. The numbers in the RR equation are representative of the percentages reported within each population. If A represents the intervention or experiment group and B is the control group, then if the RR is < 1 it means that the intervention or experiment is not as likely to happen in A as it is in B, the control. If the RR is > 1 then it means that the intervention would more likely occur in A the experimental group, than in B, the control. If both populations equal each other than A/B would give an RR of 1, implying that there is no difference between the two groups (Sheldrick, Chung, & Jacobson, 2017).
References:
Aamir, O. (2016). Selecting the appropriate study design: Case–control and cohort study designs. Journal of Health Specialties, 4(1), 37-41. doi:10.4103/1658-600X.173842
Evans, D. W., Lucas, N., & Kerry, R. (2016). Time, space and form: Necessary for causation in health, disease and intervention? Medicine, Health Care, And Philosophy, 19(2), 207-213. doi:10.1007/s11019-015-9662-5 Sheldrick, R. C., Chung, P. J., & Jacobson, R. M. (2017). Math Matters: How misinterpretation of odds ratios and risk ratios may influence conclusions. Academic Pediatrics, 17(1), 1-3. doi:10.1016/j.acap.2016.10.008
Participation for MSN
Threaded Discussion Guiding Principles
The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Participation Guidelines
Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.
Direct Quotes
Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.
Grading Rubric Guidelines
Performance Category109840ScholarlinessDemonstrates achievement of scholarly inquiry for professional and academic decisions.Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisionsEvaluates literature resources to develop a comprehensive analysis or synthesis.Uses valid, relevant, and reliable outside sources to contribute to the threaded discussionProvides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.Evaluates information from source(s) to develop a coherent analysis or synthesis.Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.Demonstrates little or no understanding of the topic.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) without any interpretation/evaluation.The posting uses information that is not valid, relevant, or reliableNo evidence of the use of scholarly inquiry to inform or change professional or academic decisions.Information is not valid, relevant, or reliablePerformance Category 109840Application of Course Knowledge -Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situationsPosts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;Applies concepts to personal experience in the professional setting and or relevant application to real life.Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.Applies concepts to personal experience in their professional setting and or relevant application to real lifeInteractions with classmates are relevant to the discussion topic but do not make direct reference to lesson contentPosts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifeDoes not demonstrate a solid understanding of the principles and concepts presented in the lessonPosts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.Posts are superficial and do not reflect an understanding of the lesson contentDoes not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifePosts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignoredNo discussion of lesson concepts to personal experience in the professional setting and or relevant application to real lifePerformance Category 54320Interactive DialogueReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.(5 points possible per graded thread)Exceeds minimum post requirementsReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over
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