The Original post below please review. Below this original post have got another original post and how it has been reviewed so please go through tha

The Original post below please review. Below this original post have got another original post and how it has been reviewed so please go through that example below and review this Diabetic wound ulcer.

Diabetic Wound Ulcer

The chosen clinical problem is the management and treatment of diabetic foot ulcers,a condition that the Diabetes Feet Australia (DFA), while releasing 2021 guidelines formanagement, pointed out that is a leading cause of morbidity, mortality as well as healthcarecost burdens in Australia.

In illustrating factors to severity of diabetic foot ulcer, Jalilian etal.(2020) also points out that diabetic foot ulcer can be a cause of high rates of amputation,

healthcare costs and even death.

Failures in healing or whenever the wounds take too muchtime to heal, amputation surgery or prolonged stay in hospital, followed by lengthy

rehabilitation, are serious health problems that people with diabetes mellitus, termed as risk

groups, often face.

As a common and serious health problem, I have chosen to draw

comparisons in terms of accelerated healing between the outcomes of applying negative

pressure wound therapy versus standard moist therapy treatment options.Prolonged healing of diabetic wounds among diabetic persons has been an issue of

concern and Oliver and Mutluoglu (2022) state that it is the most common complicationamong patients with diabetes mellitus that is not well controlled. Typically, the disease ischronic, often leading to dressing challenges or multiple amputations. Oliver and Mutluoglu(2022) advocates for an interprofessional approach as having the best outcome in the

management of the disease, a reasoning that triggered my weighing of negative pressure

wound therapy against the standard moist therapy in relation to accelerated healing.

according to Liu et al. (2018), there has been lots of recommendations to using negativepressure wound therapy instead of moist wound therapy, pointing out to costs, effectivenessand lessened need for amputation, reduced chances of infection and accelerated healingprocess. Blume et al. (2018) also links the negative pressure therapy to decreased duration forcomplete wound closure.

PICO:

P: Patients requiring dressing for diabetic foot ulcer

I: Negative wound pressure. therapy.

C: Moist wound therapy.

O: Accelerated healing process.

Research Question;Does negative wound therapy decreasing the healing time for diabetic foot ulcers as

compared to the standard moist wound therapy?

Articles addressing the research question are the articles by Liu et al. (2018). and thearticle by Blume et al. (2018). Liu (2018) studied 11 randomized control trials with more than900 participants. Although the study pointed out to the need for further trials on whethernegative pressure therapy or moist wound therapy worked best for diabetic wound, outcomes of the randomized control trials suggested that negative wound therapy had a positive

outcome in terms of healing wounds as compared to moist wound therapy.

The article by Blume et al. (2018) is a randomized control trial in America by theAmerican Diabetes Association, exploring the duration it takes a stage 3 diabetic foot ulcer tocome to complete closure. Having randomly assigned patients either negative pressure wound

therapy or moist wound therapy, results for the control trial showed that it took 96 days for a

complete wound closure for the negative pressure therapy and 112 days for complete closure

among patients subjected to moist wound therapy. A conclusion was drawn that the negative

pressure healing had reduced healing time, fewer secondary amputations and cost

effectiveness.

References:

Jalilian, M., Sarbarzeh, P. A., & Oubari, S. (2020). Factors related to severity of diabetic footulcer: a systematic review. Diabetes, metabolic syndrome and obesity: targets andtherapy, 13, 1835.

Diabetes Feet Australia (2021). 2021 evidence-based Australian guidelines for diabetesrelated foot disease. https://www.diabetesfeetaustralia.org/new-guidelines/

Oliver, T. I., & Mutluoglu, M. (2022). Diabetic foot ulcer.

https://www.ncbi.nlm.nih.gov/books/NBK537328/

Liu,Z.,Dumville,J.,Hinchchliffe,R.,Cullum,N.,Game,F.,Stubbs,N.,Sweeting,M.,&Pein

emann,F.(2018)Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus.17(10). Doi: HTTPs://10.1002/14651858.CDO10318.pub3.Blume, P.A., Walter,J.,Payne,W.,Ayla,J.,& Lantis,J.(2018)Comparison of negative pressurewound therapy using vacuum assisted closure with advanced moist woundtherapy in

the treatment of diabetic foot ulcers: a multicenter randomized controlledtrial.Diabetes care, 31(4),631.

Example below.

Example 1 (part A original post):

In order to establish a clinical research question, I employed the PICO framework. The aim was to examine appropriate goals of care for patients living with dementia established through quantitative research. Four key references were drawn upon for analysis with conclusive data determining the recommended outcome.

Having exposure within acute medical nursing, I often witness pharmacological intervention utilised as first-line behavioural and psychological symptoms of dementia (BPSD) reduction tool. The aforementioned question provides opportunity to delve deeper and gain insight regarding shortterm and long-term outcomes with such actions. Research from Douglas et al. (2018) signifies that the use of pharmacological approaches, namely, anti-psychotics medications, often are embraced as first-line interventions, despite the wealth of evidence demonstrating adverse repercussions that ensue.

P = Patients living with dementia

I = Pharmacological intervention

C = Non-pharmacological intervention

O = Effective behaviour management

Research question: In patients living with dementia, is pharmacological intervention compared to non-pharmacological intervention more effective in behaviour management?

To generalize dementia, the gradual decrease in cognitive function resulting in widespread multifactorial dysregulation of the physiological and health related quality of life (HRQL).

Dyer et al. (2017) reinforces that resultant of a deterioration in ones ability to communicate, unmet needs may be reflected in changed behaviours, or increased BPSD. Kongpakwattana et al. (2018) extends on this with postulating that eighty percent of dementia-affected persons exhibit BPSD. Dyer et al. (2017) constructed a systematic review of randomised controlled trials (RCT) on pharmacological and non-pharmacological BPSD interventions. The information conveyed fifteen systematic reviews, listed eighteen different interventions and had a standardized mean surveying dementia-affected adults through avenues such as musical therapy, analgesic therapies, antipsychotics, and cholinesterase inhibitors. The report revealed that the effect size for most interventions was considered small, whereas pharmacological interventions yielded a larger result. Non-pharmacological and functional analysis-based interventions (FABI, interventions modelled on expectant reasons behaviours are elicited) demonstrated significant improvement in regards to BPSD with fewer adverse risks involved.

Healthcare providers should consider examining physical illness including infections, dehydration, constipation and sleep disturbance as precipitants for behavioural change and apply relevant FABI (Douglas et al., 2018). The authors further discuss incident of inappropriate prescribing amounting to forty percent of dementia-affected persons not requiring anti-psychotic drugs.

Through RCT meta-analysis, Ballard et al. (2016) researched sixteen care homes, including three hundred participants over a nine month period to determine if a reduction in anti-psychotic use improved HRQL. To summarise, the review conferred a significant fifty percent reduction in antipsychotics contributed to nil significant increase in BPSD. There was also a thirty percent reduction in adverse effects for those receiving both anti-psychotics and social interaction. In this study, Ballard et al. (2016) also alarmingly discovered that anti-psychotic medication worsened HRQL by a factor of 4.54 points. A significant secondary finding demonstrated non-pharmacological interventions improved HRQL by 6.04 points.

Examining the benefits of engaging in non-pharmacological and FABI, Douglas et al. (2018) revealed that both have similar effects with a higher degree of HRQL for patients than pharmacological intervention whilst providing a lower risk of adverse events. Therefore, policy and standards of practice should embrace interventions that produce the least harm. Given the frequent emergence of evidence supporting steering away from pharmacological interventions, only specific situations should warrant such interventions such as immediate risk of harm and severe distress (Kongpakwattana et al. 2018).

Example 1 (part B Peer Feedback):

In response to the research question by XXX, In Patients living with Dementia, is pharmacological intervention compared to non-pharmacological intervention more effective in behaviour management? I have completed my own further research as I have an interest in this particular topic due to working in the health profession, I see a lot of these challenges throughout my workplace and reach to understand this in more detail. There have been times where patients that have Dementia are suffering from delusions and have become agitated along with behavioural changes. Treatment for this has usually been based on the Biomedical model through prescribing medications in order to manage Behavioural and Psychological symptoms of Dementia (BPSD) (Emblad & MukaetovaLadinska, 2021).

The first article that I have chosen to investigate is based on non-Pharmacological interventions for BPSD. A systematic approach was conducted between January 2015 to June 2020 with over seventeen studies completed being 2 of them as qualitative and the other 15 studies as quantitative. There was a total of 853 participants each with their own carer. The study focuses on four main aspects: wellbeing, quality of life (QOL), cognitive function and behavioural and psychological symptoms of dementia (BPSD) (Emblad & Mukaetova-Ladinska, 2021). The results showed significant outcomes with increased QOL, where the other two results for BPSD and wellbeing had minimal changes. Other outcomes noted in this research had shown that with non-pharmacological interventions, there had also been reduced side-effects along with minimal clinical symptoms (Emblad & MukaetovaLadinska, 2021). There were two main forms which non-pharmacological interventions focus on being the first: Structured forms in which the patient is guided with daily activities by the carer and the second, was unstructured forms where the patient leads the activities. This was dependant on the severity of the patient with Dementia. It allows the patient to be in control and focus on what they would like to do which reduces agitation and behavioural concerns (Emblad & Mukaetova-Ladinska, 2021). These structures allowed expansion of communication between the carer and the person with dementia.

When investigating the pharmacological interventions, a research article by (Dyer et al., 2017), conducted a systematic overview during 2015 to 2020 for an age group between 70- 85 years old in a Random Controlled Trial (RCT) where 15 systematic reviews and 7 of them were pharmacological interventions. These particular medications that were applied were for the treatment of Behavioural and psychological symptoms of dementia (BPSD). In particular, the medication used during these studies were anti-depressants, Melatonin, antipsychotics and Cholinesterase inhibitors (Dyer et al., 2017). These medications had significant results however, adverse effects were almost always present when administered. Analgesia was also given as part of the treatment for severe dementia with a step-up approach (Dyer et al., 2017). Pharmacological treatment is applied when a person with dementia has suffered acute symptoms. It is used as a second line treatment to non-pharmacological interventions however is used when all other treatments fail and the person is at risk to themselves or others. When both Pharmacological and non-pharmacological interventions are applied, they work well together. Results do show that therapy-based treatment tends to work better with less adverse effects.

References

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