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HLSC122 Inquiry In Health Care Questions Scenario Leah is a 21 year old health science’s student at an Australian university. She has travelled from her home country (United States [US]) to study a semester in Australia. While living with three other international students she has reported gaining weight particularly around her abdomen, from not eating healthy meals, and not exercising regularly. Leah is enjoying living away from home, socializing and going out to parties and experimenting with different mixed alcoholic drinks and Australian take-away foods. At home in the US she enjoyed going to the gym regularly, at least four times a week. However, whilst in Australia Leah has decided not to participate in a gym, but rather spend her money elsewhere on social activities, such as going out and partying. In her spare time Leah has casual employment to supplement her lifestyle in Australia. She likes travelling and is not homesick. She would like to make changes to her lifestyle which will have a long term positive impact on her weight and eating patterns. Leah visits the university student health clinic and asks you (as a student undertaking placement there) to provide guidance with respect to her health concerns. After your initial meeting with Leah you locate two relevant research studies that you would like to critically evaluate for quality.   The following PICO question is used for a systematic search: In female university students does healthy eating compared to exercise lead to weight loss?   The following questions in Part A and Part B form the basis of your critical evaluation of each research study. Please provide answers to all questions for each study. Part A Identify the strengths and weaknesses by critically evaluating the two research studies that Leah found during her CINAHL search (Rogerson, Soltani & Copeland., 2016; Share et al., 2015). 1.  Authorship a.  Make a judgement regarding the authors’ expertise, qualifications and affiliations. b.  Are there grounds for conflict of interest related to the authors of the paper and the study findings? 2. Research Aims a. What were the research question, aims or hypothesis (if stated)? b. Explain how the authors justified the need for the study? 3. Design a. Examine the research methodology and methods used in the study? b. Justify why the methodology and methods were appropriate to meet the aims of the study? c. Who were the participants in the research study? 4. Findings a. Discuss how the findings/results/conclusion answers the stated research question, aim or hypothesis? Part B 1. Discuss how Leah’s personal circumstances may create a barrier for the application of evidence. 2. Discuss how closely the research aligns with the PICO question. Answers Part A Authorship Of The Articles Under the first article in the Journal of Nutrition, entitled, ‘Undergraduate UK nutrition education might not adequately address weight management. We have 3 authors, whom are the staff at the university of Sheffield UK. While on the second paper entitled, ‘Qualitative Analysis of Localised Sources Identified by Focal impulse and Roter Modulation Mapping in Atrial Fibrillation. The authors are medical doctors from the university of Loam Linda and Cardiac Centre. The authors are experts in the field do study hence they are qualified and the affiliations they are linked to are genuine. From analytical point of there are no conflicts of interest regarding this task with the content the writers have written. Research Aims, Design And Findings Article 1 Undergraduate UK Nutrition Education Might Not Adequately Address Weight Management Aims The objective of the study was to assess the knowledge gap of undergraduate nutritionist in their role in control management through facilitation of education based approach. It’s the role of registered nutritionist to offer education to the community with ultimate of management of weight and factors surrounding weight care for the community. Its aim was to compare the AFN the competency level of undergraduate core competency which provides the basis criteria for undergraduate Nutrition criteria with data that highlights the breadth the weight management experiences using qualitative research methodology. The study was informed by the need to ensure that Nutrition graduates from the university are competent enough in their health care practice field. Design The research methodology employed by this study is qualitative research methodology. The framework for the study was to analyse, identify and explain experiences that participants go though comparing them with core competency criteria for the Association of Nutrition. The study usage of a qualitative design is essential since the participants views were sought in the study. The setting was appropriate in that all the assessment criteria was to assess the content of the criteria used for registered nutritionist with those engaged in weight management activity and the knowledge they receive from the nutritionist concern weight management. The subjects in this research were the participants engaged in weight management practices. Findings The results of the study were that factors of concern for weight management were knowledge, exercise, planning, psychological constructs and behaviour change techniques and eating patterns and available social support. Competency criteria provided a rich guidance on the weight management issues however psychological and behavioural changes were not reflected. The study concluded that accredited nutrition course was not helpful to reflect the weight management needs and experiences of the victims undergoing weight management. Hence nutritionist require more knowledge and understanding on behaviour change and psychological knowledge in order to meet the needs of clients of weight management activities, (Rogerson, Soltani,  & Copeland, 2016). Article II Quantitative Analysis Of Localized Sources Identified By Focal Impulse And Roter Modulation Mapping In Atrial Fibrillation Aims The study under focused on concern approaches related to ablation of atrial fibrillation which includes focal impulse and rotor modulation mapping and initial results. The aim of the study was to evaluate the characteristics of atrial electro grams used in identification rotors and description of outcomes of focal impulse and rotor modulation ablation. Design The study performed catheter procedures combined with ablation for the patient in the study. The ablation procedures were performed under 24 hours. The study used quantitative analysis of atrial electro grams for identification o f rotor and to describe the acute outcomes associated with rotor modulation. The study used ablation procedures for conducting the research. The study methodology used was experimental and it is appropriate for this kind of study since patients were assessed if there was any significant change on medication plan subjected. The participants of this study were the patient themselves in the population who were undergoing FIRM guided ablation for atrial fibrillation at the UCLA medical centre between the years of January 2013 and July 2013. Findings The results of the study found out that all patients had rotor with a mean of 2.3 indicating 72%, pre-specified acute procedural endpoint was achieved at 50% of the patients. Atrial fibrillation termination indicated that less than 10 % had slowed cycle length of atrial fibrillation. The basket electrodes were within 1 cm that is 54 % LA surface area, and a mean of 31 electrodes per patient showed vales which were interpreted for atrial electro grams. The offline analysis showed that there was no difference between rotor and distant sites in the dominant frequency of entropy. Electro anatomic mapping revealed no rotation activation at focal impulse and rotor modulation site identified at 96 % of patients being positive. The study thus conducted that focal impulse rotor modulation sites were not able to show the characteristics of atrial electromagnet expected from the rotor site. Catheter ablation in these sites with PVI resulted to atrial fibrillation. The study further recommended further validation of this process to ascertain the extent of termination, (Benharash et al., 2015). Part B Leah Personal Barriers To Behaviour Change Behaviour change is a process that takes time to initiate.  It takes time and dedication to initiate a behaviour change and needs total commitment from the person. To initiate change for Leah involves the need to use a problem solving approach; hereby it involves ensuring patient care that integrates evidence approach on behaviour model which is appropriate for the patient, with adequate expertise knowledge as a nutritionist. In initiating this change there is need to assess the status of the patient and the willingness for her to lead a better life, with better outcomes and at reduced costs for the patient, (Wallis, 2012). Barriers being faced Leah should be handled in a more professional manner. For Leah she needs to identify the desired health behaviour in this case she has chosen she wants to regain healthy body status. However challenges arise when breaking the complex behaviour activity of physical exercise. Although she had developed skills on physical excise but has withdrew for the exercise activity. For her health behaviour change to be effective she needs  rein forcers and motivation factor which are healthy weight gain for her body,( Michie et al., 2008). Challenge is to ensure the desired health behaviour is changed with the desire for the purpose of behaviour change. Her inactive behaviours include, going out drinking and hanging with friends her habitual behaviours need to be changed. Behaviours cues that he is facing can be rectified by adopting a positive approach to assist her. Peer influence could affect Leah’s decision to start healthy behaviour change which she needs to consider. In this case she is still involved in her company which they are not living healthy behaviour, this can have an effect on her overall process to change the behaviour. The motivation that is pushing her of achieving good weight status should be maintained. Leah is a fun of travelling and behaviour change needs dedicated time exercises and physical activity. Thus she needs to consider priorities, despite that she travels she has to find time for her physical activity exercises at the gym. Peer pressure has been shown to be factor in healthy behaviour change. The significance of peer influence is evident in that it influences you to do things that wound have done. For Leah she has decided to change her lifestyle, but how is she to tackle the peer friends that she has been having. Her lifestyle in general is a big barrier for her healthy behaviour change and could significantly impact on her status and consequent desired behaviour. She needs to learn how to change her lifestyle of consumption of chunk, partying and concentrate on a healthy path. These significant affects even the application f evidence approached for behaviour change. Meal management and dieting needs to be changed and takes time and self confidence. Leah cannot mix behaviour change for her health and her lifestyle factors, she needs to stop the social habits she currently manages and concentrate on to revive her gym practice and the of healthy foods and the cessation of alcohol consumption, (Artinin et al., 2010). How PICO Question Relates To Research PICO is aframweork fro undertaking research, it entails 4 parts that is ; population, intervention, control and outcome. The alignment of PICO on the research question is that it can be assessed by breaking down the two; Population It refers to those who will be affected with the study. In the two researchers there is need to assess whether population factor has been used. In the first research above the population targeting was those engaged in weight management and practising physical exercises. In the PICO question, the research population which the intervention will target is Leah, while on the research articles it was targeting patience in hospital and participants of weight control activity among the participants of physical exercises. Intervention The study came up with an intervention to come up with evidence that showed that there was an inconsistency on competency taught in university to the practice for healthy management task. In both questions it has targeted interventions. In the study by Rogerson, Soltani and Copeland, (2016), the target respondents were assessed based on the interventions they were engaged and later on the research concluded that there was need to incorporate knowledge of psychological and behavioural factors need to emphasize in teaching of nutrition at the university. In the PICO research question raises the intervention issue on general terms regarding university students approach on healthy lifestyle or physical exercise activity intervention, (Coke, Smith & Booth, 2012). Controls In this research study there were no controls as this component play a crucial role in experimental studies unlike this one it was a qualitative study. In this case there is no alternative strategy in the second research article; the use of controls is used to assess the experimental study.  Patient’s s have been used as controls and experiment tools. Outcome Expected outcomes from the reaches are evident in that it, in the first research there is the outcome of competency criteria for university students’ assessment on nutrition related content. The outcome did not yield the needs of the patients on weight management. In the second research the experimental outcome found out that the arterial fibrillation were not affected by the rotor modulation. The research question in this case expects an outcome after change on the dietary behaviours of Leah, whether there could be significant weight change for the patient or not, (Stone, 2002). References Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., … & Meininger, J. C. (2010). Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults. A scientific statement from the American Heart Association. Circulation. Benharash, P., Buch, E., Frank, P., Share, M., Tung, R., Shivkumar, K., & Mandapati, R. (2015). Quantitative analysis of localized sources identified by focal impulse and roter modulation mapping in atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, CIRCEP-115. Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO the SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. Michie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008). From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied psychology, 57(4), 660-680. Rogerson, D., Soltani, H., & Copeland, R. (2016). Undergraduate UK nutrition education might not adequately address weight management. Public health nutrition, 19(02), 371-381. Stone, P. W. (2002). Popping the (PICO) question in research and evidence-based practice. Applied Nursing Research, 15(3), 197-198. Wallis, L. (2012). Barriers to implementing evidence-based practice remain high for US nurses. AJN The American Journal of Nursing, 112(12), 15.

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