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Directions: please follow explicitly *** primarily this assignment is filling in the tables- have attached all articles to use **** Use the attached “Literature Evaluation Table to complete this a
Levels of Evidence in Research Evidence Level Types of Evidence Primary Research Secondary Research LEVEL 1 Randomized-Controlled Trial: Subjects randomly assigned to intervention or control groups. Intervention group receives treatment/intervention. Comparison group receives no treatment/intervention. Clinician conducting study is unaware which group participants are assigned to which typically leads to unbiased results. X Systematic Review: Comprehensive review of existing literature which involves analyzing all articles related to the research question and summarizing findings. Researchers then make recommendations for clinical practice based on evidence from articles reviewed. X Meta-Analysis: Synthesis of findings from all single, independent studies to calculate an effect. X LEVEL 2 Cohort Studies: Studies observe large groups of people that record exposure to risk factors to find possible causes of disease. Studies gather data either moving forward (prospective) or review past data already recorded (retrospective). X LEVEL 3 Case Report Studies: Studies used to determine if there is an association between exposure and specific health outcome. Frequently used when studying rare health outcomes or diseases. X LEVEL 4 Case Report: Provides detailed report of diagnosis, treatment, response to treatment, and follow-up care of an individual patient. Case Series: Group of case reports involving patients who were given the same treatment. LEVEL 5 Animal or Laboratory Studies Primary Research: Involves active participation/observation by researchers themselves. Secondary Research: Involves summary or synthesis of data/literature that has been organized by others. *Adapted from Johns Hopkins Nursing Evidence-Based Practice: Models and Guidelines and University of Michigan Library © 2022. Grand Canyon University. All Rights Reserved.
Directions: please follow explicitly *** primarily this assignment is filling in the tables- have attached all articles to use **** Use the attached “Literature Evaluation Table to complete this a
Literature Evaluation Table – DPI Intervention Learner Name: Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed. PICOT-D Question: In adult patients in the high observation unit (HOU) at a long-term acute care hospital will implementing the Society of Critical Care Medicine (SCCM) ICU Liberation Bundle (ABCDEF), compared to current practice impact ICU readmissions over an eight-week period? Table 1: Primary Quantitative Research – Intervention (5 Articles) complete table with listed articles APA Reference (Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project) How was the data collected? Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) Outcomes/Key Findings (Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research Explanation of How the Article Supports Your Proposed Intervention Balas Barnes-Daly Devlin Hsien Pun Table 2: Additional Primary and Secondary Quantitative Research (10 Articles) complete table with listed articles APA Reference (Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary or Secondary Research Design Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project) How was the data collected? Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) Outcomes/Key Findings (Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research Explanation of How the Article Supports Your Proposed DPI Project Collinsworth Demellow Loberg Oflufison Van dee Boogard Table 3: Theoretical Framework Aligning to DPI Project Nursing Theory Selected APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project Virginia Henderson’s Nursing Needs Theory Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and Process into Practice; Virginia’s Henderson Need Theory. International Journal of Caring Sciences, 8(2), 443–450. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=102972280&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 Fill in 250 words Change Theory Selected APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention John Kotter’s Change Model Kang, S. P., Chen, Y., Svihla, V., Gallup, A., Ferris, K., & Datye, A. K. (2022). Guiding change in higher education: an emergent, iterative application of Kotter’s change model. Studies in Higher Education, 47(2), 270–289. https://doi-org.lopes.idm.oclc.org/10.1080/03075079.2020.1741540 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=155185571&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 Fill in 250 words Table 4: Clinical Practice Guidelines (If applicable to your project/practice) APA Reference – Clinical Guideline (Include the GCU permalink or working link used to access the article.) APA Reference – Original Research (All) (Include the GCU permalink or working link used to access the article.) Explanation for How Clinical Practice Guidelines Align to DPI Project Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., … Ely, E. W. (2018). Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Critical Care Medicine. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000003482 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsovi&AN=edsovi.10.1097.CCM.0000000000003482&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 Devlin, John W. PharmD, FCCM (Chair)1,2; Skrobik, Yoanna MD, FRCP(c), MSc, FCCM (Vice-Chair)3,4; Gélinas, Céline RN, PhD5; Needham, Dale M. MD, PhD6; Slooter, Arjen J. C. MD, PhD7; Pandharipande, Pratik P. MD, MSCI, FCCM8; Watson, Paula L. MD9; Weinhouse, Gerald L. MD10; Nunnally, Mark E. MD, FCCM11,12,13,14; Rochwerg, Bram MD, MSc15,16; Balas, Michele C. RN, PhD, FCCM, FAAN17,18; van den Boogaard, Mark RN, PhD19; Bosma, Karen J. MD20,21; Brummel, Nathaniel E. MD, MSCI22,23; Chanques, Gerald MD, PhD24,25; Denehy, Linda PT, PhD26; Drouot, Xavier MD, PhD27,28; Fraser, Gilles L. PharmD, MCCM29; Harris, Jocelyn E. OT, PhD30; Joffe, Aaron M. DO, FCCM31; Kho, Michelle E. PT, PhD30; Kress, John P. MD32; Lanphere, Julie A. DO33; McKinley, Sharon RN, PhD34; Neufeld, Karin J. MD, MPH35; Pisani, Margaret A. MD, MPH36; Payen, Jean-Francois MD, PhD37; Pun, Brenda T. RN, DNP23; Puntillo, Kathleen A. RN, PhD, FCCM38; Riker, Richard R. MD, FCCM29; Robinson, Bryce R. H. MD, MS, FACS, FCCM39; Shehabi, Yahya MD, PhD, FCICM40; Szumita, Paul M. PharmD, FCCM41; Winkelman, Chris RN, PhD, FCCM42; Centofanti, John E. MD, MSc43; Price, Carrie MLS44; Nikayin, Sina MD45; Misak, Cheryl J. PhD46; Flood, Pamela D. MD47; Kiedrowski, Ken MA48; Alhazzani, Waleed MD, MSc (Methodology Chair)16,49 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, Critical Care Medicine: September 2018 – Volume 46 – Issue 9 – p e825-e873 doi: 10.1097/CCM.0000000000003299 https://journals.lww.com/ccmjournal/Fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx Fill in read Devlin’s article to fill in © 2022. Grand Canyon University. All Rights Reserved.
Directions: please follow explicitly *** primarily this assignment is filling in the tables- have attached all articles to use **** Use the attached “Literature Evaluation Table to complete this a
Downloaded from<004B005700570053001D00120012004D00520058005500510044004F00560011004F005A005A001100460052005000120046 00460050004D00520058005500510044004F> by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on02/20/2022 Downloadedfrom<004B005700570053001D00120012004D00520058005500510044004F00560011004F005A005A001100460052005000120046 00460050004D00520058005500510044004F> by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on02/20/2022Critical Care Medicine www.ccmjournal.org 171 Objectives: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agita- tion, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in commu- nity hospitals. Design: A prospective cohort quality improvement initiative involv- ing ICU patients. Setting: Seven community hospitals within California’s Sutter Health System. Patients: Ventilated and nonventilated general medical and surgi- cal ICU patients enrolled between January 1, 2014, and December 31, 2014. Measurements and Main Results: Total and partial bundle compli- ance were measured daily. Random effects regression was used to determine the association between ABCDEF bundle compliance accounting for total compliance (all or none) or for partial compliance (“dose” or number of bundle elements used) and outcomes of hos- pital survival and delirium-free and coma-free days, after adjusting for age, severity of illness, and presence of mechanical ventilation. Of 6,064 patients, a total of 586 (9.7%) died before hospital dis- charge. For every 10% increase in total bundle compliance, patients had a 7% higher odds of hospital survival (odds ratio, 1.07; 95% CI, 1.04–1.11; p < 0.001). Likewise, for every 10% increase in par- tial bundle compliance, patients had a 15% higher hospital survival (odds ratio, 1.15; 95% CI, 1.09–1.22; p < 0.001). These results were even more striking (12% and 23% higher odds of survival per 10% increase in bundle compliance, respectively, p < 0.001) in a sensitivity analysis removing ICU patients identified as receiv- ing palliative care. Patients experienced more days alive and free of delirium and coma with both total bundle compliance (incident rate ratio, 1.02; 95% CI, 1.01–1.04; p = 0.004) and partial bundle com- pliance (incident rate ratio, 1.15; 95% CI, 1.09–1.22; p < 0.001). Conclusions: The evidence-based ABCDEF bundle was success- fully implemented in seven community hospital ICUs using an inter- professional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation. (Crit Care Med 2017; 45:171–178) Key Words: ABCDEF bundle; delirium; ICU liberation; interprofessional; mobilization; sedation K nowledge derived through epidemiologic investigations has contributed to a growing understanding of the far- reaching effects of critical illness (1, 2), emphasizing the need to help mitigate patient suffering and improve quality of care and patient safety both during and after care in the ICU. Society of Critical Care Medicine’s (SCCM’s) “Clinical Practice Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.0000000000002149 *See also p. 363.1Office of Patient Experience, Sutter Health Systems, Sacramento, CA.2Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH. 3Department of Medicine, Pulmonary and Critical Care and Health Services Research Center, Vanderbilt University School of Medicine, Nashville, TN. 4The Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN. Supported, in part, by a grant from the Gordon and Betty Moore Foundation. Dr. Barnes-Daly has received honoraria from the Society of Critical Care Medicine and a grant from the Gordon and Betty Moore Foundation for the ICU Liberation project. Her institution received funding from the Gordon a nd Betty Moore Foundation. Mr. Phillips received funding from Sutter Health. Dr. Ely has received honoraria from Abbott Laboratories, Hospira, and Orio n for continuing medical education activities and is funded by both the Na tional Institutes of Health (NIH) and Veteran’s Affairs Geriatric Research Education Clinical Center. He received support for article research from the NIH and received funding from Orion and Abbott. His institution received funding from the NIH and Hospira. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal). For information regarding this article, E-mail: [email protected] Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients* Mary Ann Barnes-Daly, MS, RN, CCRN, DC 1; Gary Phillips, MAS 2; E. Wesley Ely, MD, MPH, FCCM 3,4 Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Barnes-Daly et al 172 www.ccmjournal.org February 2017 • Volume 45 • Number 2 Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit” (PAD guideline) is an extensive set of evidence-based recommendations address- ing key elements of quality and safety and suffering for patients during critical illness (3). The R ethinking Critical Care initia- tive sponsored by the Institute for Healthcare Improvement and other investigations over the past 20 years have helped hun- dreds of hospitals focus on patient comfort and safety issues in the ICU related to pain, sedation, delirium, and early mobility, evolving into a bundle of care (4–6). Subsequent investigations of various permutations of this bundle have been favorable (4, 7–13), yet more data are needed. To that end, the revised A ssess, prevent, and manage pain; Both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs); C hoice of Seda- tion/Analgesia; Delirium monitoring and management; E arly mobility and exercise; and F amily engagement and empower - ment (ABCDEF) bundle was developed as an evidence-based strategy to implement the P AD guidelines. The robust nature of the evidence in support of this bundle’s individual elements (3–5, 7, 11, 14–37) led the SCCM to begin its national ICU Lib- eration Collaborative. At the same time, continuing to generate an understanding of the utility of these elements as a b undle in a community setting is important. The quality improvement (QI) initiative described here was designed to utilize an interprofes- sional team (IPT) model to implement the ABCDEF bundle as configured by Sutter Health in seven community-based ICUs in California (38). The aim was to study the relationship between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days (DFCFDs). MATERIALS AND METHODS Study Design One IPT at each of seven Sutter Health–affiliated ICUs was trained on IPT concepts and the clinical aspects of the ABCDEF bundle. Each ICU-based team consisted of a dedicated regis- tered nurse (RN), an administrative RN, a pharmacist, a physi- cal therapist, a respiratory care practitioner (RCP), and an ICU physician. This project was reviewed by the Sutter Health Insti- tutional Review Board, who considered it a QI initiative that did not require consent. Timeline The study period was calendar year 2014. A 12-week IPT training and multiple clinical education programs were provided to each ICU team in a staggered fashion beginning the fourth quarter of 2013 through the second quarter of 2014. The IPT educa- tion program, IPT model, and collaborative functionality of the IPT have previously been well-described (38). Additional clini- cal education was provided to the IPT members through atten- dance at conferences and lectures given by nationally recognized subject matter experts early in the study period. Study Sites The ABCDEF bundle was implemented by the IPT in ICUs ranging from six to 16 beds at seven Sutter Health community hospitals. All units were open, mixed general medical and sur - gical ICUs, and only the three largest hospitals were staffed with intensivists. All hospitals had care augmentation from the remote electronic ICU (eICU) RN and physician staff. Study Procedures The ABCDEF bundle elements were implemented for every patient every day. The elements are described in detail at www. iculiberation.org (39) and by Frimpong et al (40). Note that as part of the 2015–2017 ICU Liberation Collaborative, the bun- dle letters were adjusted to reflect explicitly the inclusion of assessment, prevention, and management of pain as Element A. Accordingly, we advise the reader to see www.iculiberation. org and www.icudelirium.org (39, 41) for the most current description of the ABCDEF bundle. At the time of this 2014 QI study, we operated with the following rubric: Element A: SAT involved completely turning off all sedative infusions as well as analgesic infusions if the patient was not having active pain. Element B: SBT was considered compliant for patients receiv- ing mechanical ventilation (MV) if they were placed on CPAP/ PSV 5/5 or blow-by for a minimum of 30 minutes after having passed a safety screen. Element C1 required the coordination of Elements A and B by actual communication between the RN and RCP performing Elements A and B. This was verbalized in rounds as having happened or not. Element C2 consisted of a statement by the ICU pharmacist that the PAD guidelines for sedation were being followed (i.e., light sedation target, avoid- ance of benzodiazepines, and an analgosedation [pain-first] approach). Element D was met if the Confusion Assessment Method for the ICU (CAM-ICU) had been used to assess the patient on both the current shift and the prior shift. Element E was met if the patient had been mobilized to maximum potential after passing a mobility safety screen. Element F was met if the patient/family had participated in rounds or a fam- ily conference had been held. All of these elements had to be accomplished during the previous 24 hours (rounds yesterday to rounds today) to be considered total compliance for that time period. Patient characteristics are shown in Table 1. The ABCDEF bundle was addressed each morning during ICU rounds using the IPT collaborative model. Both MV and nonventilated patients were eligible for the bundle in an opt-out fashion. All elements of the bundle were contained in a standardized order set (Supplemental Fig. 1, Supplemental Digital Content 1, http:// links.lww.com/CCM/C232). Patients were excluded in certain instances such as active ethanol/drug withdrawal, open abdo- men, significant hemodynamic or respiratory instability, new coronary ischemia, therapeutic neuromuscular blockade, or intubation within the previous 6 hours without stabilization. Bundle-specific safety screens were used to exclude patients who were not clinically stable to have the SAT, the SBT, and the exercise/ early-mobility protocol (E) (supplemental data, Supplemental Digital Content 2, http://links.lww.com/CCM/C233). Each patient was evaluated for level of arousal/sedation and for the presence of delirium using the Richmond Agitation and Sedation Scale (RASS) and the CAM-ICU (22, 23, 37). Sedation Copyright 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Critical Care Medicine www.ccmjournal.org 173 was titrated or removed completely to meet a prescribed RASS target. This target allowed patients to be awake and respon- sive, permitting performance of the delirium assessment and completion of the other bundle elements.During discussion of the implementation of the ABCDEF bundle, the full impact of the bundle was thought to be most evident in patients explicitly seeking recovery and survival. In contrast, patients whose focus of care had shifted to palliation of suffering were expected to be affected less by implementa- tion of the ABCDEF bundle. Therefore, a subgroup analysis of patients with and without a palliative care consult was planned a priori to measure the differential importance of bundle com- pliance in those two groups of patients related to survival and DFCFDs. Data Collection Data were collected each day by the IPT RN in each ICU dur - ing daily rounds and entered into an electronic data collection tool (MIDAS; Kitware, Clifton Park, NY). To reduce the data burden for the individual units, data collection responsibilities were transitioned to the eICU staff, who participated in rounds remotely as active members of the ICU care team and entered the data in real time. Monthly dashboard reports were gener - ated to track total and partial bundle compliance and patient outcome data. Statistical Methods Analyses addressed the relationship between bundle com- pliance (independent variable) versus hospital survival and DFCFDs (two dependent/outcome variables). Independent Variables. Bundle compliance was mea- sured in two ways: 1) total compliance was defined as the proportion of days during a patient’s ICU stay that he or she received all elements of the ABCDEF bundle for which the patient was eligible on a given day and 2) partial compliance was an acknowledgment that some effect on outcomes may result from clinicians’ using some elements of the bundle even though not all bundle elements could be completed. Thus, partial compliance was used to determine the dose of compliance when something less than total compliance was provided to a given patient on a given day. This was calcu- lated in two steps. First, a proportion was generated by tak- ing the number of the individual elements in a particular day that a patient received and dividing that by the number of elements that he or she was eligible to receive. Then the partial compliance was defined as the mean of all of that patient’s proportions during his or her ICU stay (i.e., for all ICU days). Dependent (Outcome) Variables. The two main out- comes variables are: 1) hospital survival was tracked pro- spectively and calculated as the percent of patients still alive at hospital discharge; 2) DFCFDs were also tracked prospec- tively using the CAM-ICU (37) and RASS (22, 23) and cal- culated as the number of days a patient was alive and free of both delirium (i.e., CAM-ICU negative) and coma (i.e., any RASS other than –4 or –5) of that person’s total ICU dura- tion. CAM-ICU and RASS monitoring were only conducted while patients were in the ICU, thus only ICU days were used to determine the presence or absence of delirium and coma. Statistical Modeling. The two outcomes were regressed on each of the two independent variables (total and partial com- pliance). Because patients were seen in seven ICUs (affiliates) in the Sutter Health System, the analysis included the specific ICU as a random term in the regression analysis. Random effects logistic regression was used when analyzing hospital survival, whereas random effects negative binomial regression was used T Ab LE 1. Patient Demographics and baseline Clinical Characteristics Characteristic Statistic No. of patients in study, n6,064 Age in years, mean ( sd) 63.1 (17.4) Sex, n (%) Male 3,236 (53.1) Female 2,828 (46.6) Race, n (%) White 4,468 (73.7) Black 638 (10.5) Asian 319 (5.3) Native American 56 (0.9) Other/unknown 583 (9.6) Acute Physiology and Chronic Health Evaluation III, mean ( sd) 92.0 (26.0) Percent with any mechanical ventilation, n (%) 1,438 (23.7) Admit status, n (%) Elective 627 (10.3) Emergency 3,957 (65.3) Urgent/trauma 1,480 (24.4) Palliative care, n (%) No 5,471 (90.2) Ye s 593 (9.8) Affiliate, n (%) 1 495 (8.2) 2 505 (8.3) 3 213 (3.5) 4 1,061 (17.5) 5 1,575 (26.0) 6 1,269 (20.9) 7 946 (15.6) Acute Physiology and Chronic Health Evaluation III range is 0–299. Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Feature Articles Barnes-Daly et al 174 www.ccmjournal.org February 2017 • Volume 45 • Number 2 when analyzing the number of DFCFDs. Both of these regres- sion methods were run separately when total compliance was the independent variable and when partial compliance was the independent variable. Negative binomial regression was used as opposed to Poisson regression because the variance was over dispersed. ICU length of stay (LOS) was used as the exposure variable in this regression to control for the variable length of time the patient was in the ICU. Random effects logistic regression analysis produced hospi- tal survival odds ratios (ORs) for a 0.1 unit increase for both independent (i.e., bundle compliance) variables. Thus the ORs estimate the increase in hospital survival for every 0.1 increase in the bundle compliance proportion. Similarly, random effect negative binomial regression produced incident rate ratios (IRRs) for a 0.1 unit increase for both bundle compli- ance variables. Here the IRRs estimate the increase in the rate of DFCFDs for every 0.1 increase in the proportion of bundle compliance. The goal of this investigation was to identify the true relation- ship between total or partial compliance and hospital survival; therefore, a risk factor (bundle compliance as the independent variable) modeling approach was used to determine which covariates to add to the random effect regression model. The OR and the IRR describe the relationship between the depen- dent variable (i.e., hospital survival and DFCFDs, respectively) and total or partial bundle compliance in the regression. When determining other covariates to add to the regression model, only covariates that change the total or partial compliance OR or IRR (i.e., confounders) were included. These confounders of the relationship were determined as those that changed the relationship by more than 10% in either direction. Covariates that had a statistically significant interaction with total or par - tial compliance (p < 0.05) were also included in the model as they are effect modifiers. If a confounder or an effect modifier was found, the analysis was adjusted for this covariate. It was determined a priori that age and Acute Physiology and Chronic Health Evaluation (APACHE) III would be included in all risk-adjusted models regardless of whether or not they were confounders. APACHE III was missing in 2.9% of the observations and was thus imputed using multiple imputation (M = 20) using truncated linear regression where the lower and upper limit of the truncation was set at the observed minimum and maximum values of 7 and 194, respec- tively. The predictor variables in the imputation included patient age, sex, race, admission status (elective, emergency, trauma, or urgent), whether or not the patient was receiving sedation, hospital LOS, and affiliate location. All analyses were run using Stata 14.1 (StataCorp, College Station, TX). RESULTS Demographics and baseline Characteristics In total, 6,064 unique patients were included in the study. Patient demographic information and baseline characteris- tics are summarized in Table 1. Approximately one quarter of the patients were on MV at some point during their ICU stay making them eligible for all ABCDEF bundle elements on those days. Patients who were not receiving MV on a par - ticular day and those who never received MV would not be eligible for the A, B, or C 1 elements of the bundle on those particular days, which was accounted for in assessing bundle compliance. Patient Outcomes and Compliance Statistics Table 2 shows that one in 10 patients died before they left the hospital (n = 586 [9.7%]), after a median ICU and hospital LOS of 3 and 5 days, respectively. Table 2 also demonstrates a high rate for both total (all or none; 89%, 95% CI) and partial ABCDEF bundle compliance (95%, 95% CI). Ab CDEF bundle Compliance

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ASSIGNMENT 2 (4 full pages) Case: Health care professional to family as client (teaching and learning) Sarah and Matt have a 5 year old boy named Sam. Sam is “big” for his age with a BMI over the norm
ASSIGNMENT 2 (4 full pages) Case: Health care professional to family as client (teaching and learning) Sarah and Matt have a 5 year old boy named Sam. Sam is “big” for his age with a BMI over the normal for a boy his age. Write learning objectives to guide your teaching of Sam’s family related to the importance of physical activity for maintain optimal weight in children. This assignment, writing of learning objectives, will allow you to gain knowledge that is foundational to the teaching learning process and provide you with the opportunity to partially achieve the course learning outcome: apply the teaching and learning process to a health-related situation in a systematic manner that reflects the principles of teaching and learning. Based on the case study a clear, measurable objective must be written for each of the 3 domains cognitive, affective, and psychomotor. Evaluation Criteria for Assignment 2 – Writing Learning Objectives Articulate three objectives, one for each domain. Each objective is: learner-centered and discrete; written in clear, measurable terms; reflective of your assigned case study; reasonable for a three minute teaching session Cognitive (4 marks) Affective (4 marks) Psychomotor (4 marks) Research Paper and essay writing SMART objectives: http://www.cno.org/globalassets/docs/qa/developingsmartgoals.pdf Provide rationale including integration of theoretical knowledge that is, evidence-based practice to support each objective (4 marks) To demonstrate integration of theoretical knowledge for each of the objectives (each linked to a learning domain). Please note the following website as it is useful and provides a simple explanation of each of the three domains: http://www.nwlink.com/~donclark/hrd/bloom.html Make sure you read to the bottom of the website to “Next Steps” as it links to the affective and psychomotor domains. Consider the levels of learning for each domain (Remembering, Understanding, Applying etc.) with appropriate verbs and activities for learning for each level of learning. Once you have written the learning objective in a SMART format, a discussion of the level learning must be completed to demonstrate your understanding of the theoretical knowledge for domains of learning. This must relate to the objective’s measurable outcome. Provide the learning theory of influence (review the WHO (2012) document and which teaching model best relates to the objective and why. http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf ) Provide evidence of application of course concepts and references of external sources as needed to support each learner centered objective (4 marks) Consider for each objective (domains): your personal learning and teaching philosophy, patient learning style(s), resources that will be used, teaching location, motivation of learner, how can/does learning become included in patient care? Accurate APA format including: Title page, headings and subheadings (1 mark) References in the body of the paper (2 marks) Reference citations in the references list (2 marks) Accurate scholarly format including: 4 full pages in length, excluding title page and References list (1 mark) Introduction as directed at essay writing (1 mark) Scholarly language and professional tone  (1 mark) Grammar, spelling, and punctuation (1 mark) Conclusion (1 mark) PLEASE See this example assignment and follow the format Case: https://www.studocu.com/en-ca/document/athabasca-university/teaching-and-learning-for-health-professionals/mandatory-assignments/hlst-320-assignment-2/6746943/view use the references that I provided above, you can add some more when needed

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