Reply to 2 discussion post and cite sources.
first discussion post:
Ishee, Candace, Adv Concepts of Nursing
Evidence based practice offers a range of benefits for healthcare staff and patients by promoting positive patient outcomes, reducing health care cost, reducing complications and contributing to the growth of healthcare science. New evidence and changes occur everyday so it is important to be up to date on more recent evidence regarding your practice.
My proposed question would be regarding Swan Ganz catheter usage. Do patients who receive a pulmonary artery catheter (Swan Ganz) with hemodynamic monitoring have fewer complications and better survival rates than those who do not receive one in the first few days post-cardiac surgeries/cardiogenic shock? The conclusion to this answer varies according to several researchers and articles. One side of the discussion is that clinical studies show a lack of efficacy and promotes potential harmful effects of the client that can be avoided versus hemodynamic trends may potentially effect treatment options, guiding the use of care and warrant further attention before complications develop. Some surgeons have completely removed the use of Swan Ganz catheters from practice completely, whereas others try to limit the use to those the benefit out weighs the risk. “The PAC should be reserved for the minority of cases where, despite attempts to optimize therapy, further hemodynamic information is required and where these data can be interpreted and utilized correctly” (Lapinsky, 2002). Randomized clinical trails have established that routine use of PAC is not necessary and associated with increasing complications. However, it is significantly needed in cardiac surgical patients and in patients with cardiogenic shock for diagnosis and treatment maintenance. The vast majority of researchers have concluded that the use of Swan Ganz catheter usage is appropriate for a select minority where benefits out weigh the risks.
I recently had a patient whom had abdominal surgery that day that shortly after began bleeding out and went into cardiogenic and hypovolemic shock. With her being on a medical surgical floor, the resources were not available to monitor her continuously, resulting in her developing and going into shock. The patient ultimately had to receive many units of blood and go back to OR. I believe if she had been in ICU and had a PAC placed with continuous monitoring this could of been prevented and / or caught early to prevent this complication from developing resulting in a longer hospital stay and higher health care costs.
Lapinsky, S. E., & Richards, G. A. (2003). Pro/con clinical debate: pulmonary artery catheters increase the morbidity and mortality of intensive care unit patients. Critical Care, 7(2), 101. https://doi.org/10.1186/cc1872
Chatterjee, K. (2009). The Swan-Ganz Catheters: Past, Present, and future. Circulation, 119(1), 147–152. https://doi.org/10.1161/circulationaha.108.811141
2nd discussion post
Shernell Long DB#2
Importance of Evidence-Based Practice in Liver Transplants
Liver transplantation is a complex medical procedure that can significantly impact the quality and duration of life for patients with end-stage liver disease. In recent years, the field of liver transplantation has seen advancements in surgical techniques, immunosuppressive therapies, and patient management strategies. However, ensuring optimal outcomes for liver transplant recipients requires a strong emphasis on evidence-based practice (EBP).
In this world, every decision regarding patient care, from pre-transplant evaluation to post-transplant follow-up, is grounded in the best available evidence from scientific research. This approach not only improves individual patient outcomes but also enhances the overall efficiency and effectiveness of liver transplantation programs.
Can a person with multidisciplinary lifestyles receive and adapt to a liver transplant versus a recipient who receives a standard post transplant care?
P—Patient or Problem: Liver transplant recipients with non-alcoholic fatty liver disease (NAFLD) often experience post-transplant complications related to metabolic syndrome, such as insulin resistance, dyslipidemia, and obesity.
I—Intervention or Issue: Implementation of a multidisciplinary lifestyle intervention program focused on dietary modification, physical activity, and behavioral counseling tailored specifically for liver transplant recipients with NAFLD.
C—Comparison: Comparison between liver transplant recipients with NAFLD who receive the multidisciplinary lifestyle intervention program and those who receive standard post-transplant care.
O—Outcome: The primary outcome measures include improvements in metabolic parameters such as insulin sensitivity, lipid profile, body mass index (BMI), and liver histology (e.g., resolution of steatosis, inflammation, and fibrosis) assessed through laboratory tests and imaging studies.
T—Time: The study will assess outcomes at multiple time points: pre-intervention, immediately post-intervention, and at regular intervals during long-term follow-up (e.g., 6 months, 1 year, and 2 years post-transplant).
By conducting rigorous research based on the PICOT framework, liver transplant centers can tailor interventions to address specific patient populations, leading to improved clinical outcomes and enhanced quality of life for liver transplant recipients.
Rationale and Scholarly References:
Evidence-based Practice in Liver Transplantation:
Sotiropoulos GC, Paul A, Nadalin S, et al. Liver transplantation for hepatocellular carcinoma: University Hospital Essen experience and metaanalysis of prognostic factors. J Am Coll Surg. 2007;205(5):661-675.
Management of NAFLD Post-Liver Transplant:
Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547-555.
Lifestyle Intervention in Liver Transplant Recipients:
Laryea M, Watt KD, Molinari M, et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl. 2007;13(8):1109-1114.
Effectiveness of Multidisciplinary Interventions:
Yaskolka Meir A, Rinott E, Tsaban G, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut. 2021;70(10):1914-1922.
Edited by Shernell Long on Feb 10 at 1:17pm
