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Z51000080 Critical Appraisal For Public Health

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Z51000080 Critical Appraisal For Public Health Question: 1. What Are the Differences between Rapid versus Standard Intravenous Rehydration inPediatric Gastroenteritis Evidence of appropriate interpretation of the assignment task, i.e. demonstrated ability to critique scholarly literature   Demonstration of understanding of the terms used in the selected papers   Demonstration of engagement with the literature, reading and unit resources;   Attention to structure and logical sequencing of information; clearly identified introduction, body and conclusion; Answer: Structure Of The Study Design The Rapid versus standard intravenous rehydration trial was conducted in a controlled environment which utilized the single center, two arms, and the parallel randomized intravenous methods of rehydration. The trial was conducted at the Pediatric emergency department of a tertiary child care center located in Toronto, Canada. The trial would be conducted on 226 children aged between 3 months to 11 years of age which would allow for a wider variation of data related to the trail to be collected. The trail patient weight was also limited to children weighing no less than 5kg and no more than 33kg. Children who had a history of chronic systemic disease, abdominal surgery, bilious or bloody vomit, hypotension, or hypoglycemia and hyperglycemia were also excluded from the trail. Intervention/ Control The trail would see the patients being distributed equally thereafter on half would be administered with rapid intravenous rehydration which would be administered at the rate of 60/ml per KG per hour. The other half would be administered with 20ml per KG per hour and in both trails, the rehydrate would be maintained at 0.9% saline density. Analysis – Models, Intention-To-Treat? The trail would be conducted to analyze and document the differences registered on patients when hydrating using the two methods so as to prepare a detail report outlining the results and recommending any important finding that may have been identified during the trial(Tang & Tu, 2012). Outcomes – Primary And Secondary The outcome of the trial would be carefully documented and finding reported after one hour after and once again the finding would be reported and documented at the end of the second hour to detail any differences which may have been registered between rapid and standard intravenous rehydration(Wang & Bakhai, 2006). Follow-Up – Duration/Completeness, Accounting Of Patients There would be another follow up detailing the findings among the different children after a total of four hours which would be registered and added to the final report Validity To maintain the validity of the trail and avoid the trail being hampers by incorrect or altered results the trail patent list was canceled and randomized to deliver the most equality without risk of manipulated results. Manipulated results tend to cause considerable issues related to any medical trails validly which could greatly influence the results in a negative manner. To further improve the results the trail patient treatment groups were also organized in similar age groups as well as at the same stages of dehydration so as to gain the most accurate results. The 226 children treated during the trail where distributed as follows 112 were administered with the standard IV rehydration method which 114 children were administered with the rapid ID rehydration method. All 226 children who were shortlisted for rapid vs. standard IV rehydration trail where successful rehydrated after 4 days. The trail delivered successful results among children but the trail was only limited to children whereas pediatric gastroenteritis does also affect adult thus the treatment effect on patients above the age of 11 still remains unexplained. Sampling And Results Primary Outcomes Of Trial The trail would identify that the Rapid and standard intravenous rehydration would not have major differences as opposed to the rate at which the children were rehydrated. Results showed only a 7% difference between the patient recovery among the rapid and standard methods of rehydration. 41 of the 114 (36%) of the children who were administered with the rapid iv rehydration had restarted after one hour as opposed to 25% or 33/112 children administered with the standard iv rehydration method. The two-hour clinical trial would see the response rate further reduced to 5.7% among the children treated using the rapid and standard IV rehydration trail which was lower but still favors the rapid IV rehydration technique. Secondary Outcomes Of Trail The secondary clinical trial would see patients registering a higher rate of response which was 8.9%. The number of patients who had hydrated for four hours was also considerably higher due to having received rehydration for a longer period and 52% and 43% of the children rehydrated after 4 hours. Data Analsysis  Compliance With Therapies The trail would register 100% compliance among registered patients who were all administered with the treatment and the trial studies the administration of the both rapid and standard IV rehydration on the patients. Adverse Effects Intravenous rehydration concentration was limited to .9% salinity to ensure the delivery needed minerals to the body. The rapid rate of intravenous administration was also limited to a maximum of 60ml per KM per hour to avoid over hydrating the patients which could result in over diluting the patients’ blood. Overhydrating can result in the lack of adequate electrolytes and minerals in the blood stream which could result in confusion and seizures among affected patient. To avoid overhydrating the patient’s rapid intravenous hydration rate was limited to 60 ml per KG per hour and the salinity maintained at 0.9% to ensure the patients remain stable during the rehydration process. Finding Strengths And Weaknesses Of Study The trail study was aimed at registering a rapid response linked to rehydrating children suffering from severe dehydration quickly so as to prevent organ failure and death. The study would limit its trails to only administering rapid and standard intravenous rehydration at the same salinity with only the rate of rehydration being increased. This resulted in delivering unsatisfactory results due to both the rapid as well as standard and rapid rehydration techniques delivering approximately the same results on the children used and the trail study. This clearly demonstrated that the rapid rehydration technique was not considerably more efficient than the standard technique. The study would deliver unclear conclusion related to an effective rehydration method due to simply identify there was no major difference registered among the patients and conclude on the same. Study Of Other Available Literature The results were also limited to the information and data collected from the trail and did not include or report on any additional or secondary research which may have been done with similar care. This has limited the made the results of the trail unpredictable and incomplete since there is not link to external research and studies which limit the trails results. Young medical professionals and nurses will usually depend on a wider verity of literature, trails and studies to collect important information and develop treatment approached but with the trail only limiting treatment to their finding, many questions remain unanswered. The trial should have connected on previous research and finding as well as broadened their scope to deliver a wider trail result which can be used by medical professionals while performing the future treatment. The study was also limited to rehydrating the patient’s body but did not address the cause of rehydration in the children or which treatment should have also been performed alongside the rehydration process. How The Trail Will Effects My Management Of Putative Patients? With more major different registered between the rapid and standard intravenous rehydration trail, my view towards putative patient management and rehydration shall be focused towards using the standard intravenous rehydration method. This is due to there being no significant change in the level of treatment among the standard and rapid trail patients while the rapid rehydration method also attracted more risks associated with excessive blood dilution and the risk of over-hydration. The trial results have clearly demonstrated no major change thus management and care of putative patient should be limited to standard intravenous rehydration Next Steps For Further Study Of This Problem With no major development or change identity on the trail linked to rapid and standard rates of intravenous rehydration the next step linked to identifying methods of rehydrating patient fast would involve the adjustment of rehydration liquid salinity percentage. In dehydration, the Blood cells have been deprived of water which results in the inability to absorb oxygen and this lost thickens the blood which results in hampering blood flow. Besides simply diluting the blood with a saline concentrate, it is important to identify minerals and electrolytes which can be added to the hydrant to help speed up their hydration process. The main concern linked to dehydration if the bodying inability to absorb and distribute the hydrating liquid quickly from the blood stream to the muscle tissue which makes it critical to identify a manner in which this can be achieved. This will help restore patient muscle mass and help restore the patient health quickly thus reducing the risk of internal organ damage as a result of dehydration. References: Tang, W., & Tu, X. (2012). Modern Clinical Trial Analysis. New York: Springer Science & Business Media. Wang, D., & Bakhai, A. (2006). Clinical Trials: A Practical Guide to Design, Analysis, and Reporting. Chicago: Remedica.

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