QUESTION

Please see attached

literature review

Write a detailed, 2-page description of an appropriate literature search strategy and execute that strategy by locating a minimum of 20 scholarly publications. Then, analyze each source and identify main themes. Also, complete steps 2 and 3

Step 1: Develop and Execute an Appropriate Search Strategy.

Write a detailed, 2-page description of an appropriate literature search strategy. Then, use that strategy to locate a minimum of 20 scholarly sources, published within the last five years (unless seminal, practice guideline, or consensus statement), addressing your PICOT question. You may need to find additional sources if you do not have at least two sources that address the same main theme (see Step 3).

Step 2: Document and Analyze the Evidence.

Analyzing the evidence you have gathered in a literature search is necessary to develop a coherent synthesis of your findings. Use the 

Evidence Table [XLSX]


 Download Evidence Table [XLSX]
template to help you document and analyze the source materials you have located for this assessment.

Step 3: Identify Main Themes in the Literature.

Organizing your evidence by main themes or ideas addressed in each source will help you identify commonalities and differences in research questions, methodologies, and findings, and gaps in the research. Sort your evidence using the 

Main Themes Table [XLSX]


 Download Main Themes Table [XLSX]
and locate additional sources if you do not have at least two sources that address the same main theme.

w9answer1II

respond to the topic,(Peripartum depression) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Peripartum Depression

Women who are depressed during pregnancy have higher rates of use of alcohol, illicit substances, and tobacco in pregnancy, with poorer nutrition and weight gain, and lower rates of prenatal care. Untreated depression in pregnancy increases the risk of low birth weight, preterm birth, and neonatal intensive care unit admission (Konstanatinou et al 2020). Peripartum Depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. Symptoms of peripartum depression persist for more than two weeks and include anhedonia, decreased energy, reduced appetite, and poor concentration (Justesen & Jourdaine, 2023).

·
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

SSRIs are the first choice for moderate to severe peripartum depression treatment. In a randomized controlled trial comparing antidepressants with community-based psychosocial intervention for peripartum depression, SSRIs were superior, with a number needed to treat at four weeks.  Postpartum women can be sensitive to medications because of hormone effects on liver enzymes, increased volume of distribution, and increased levels of drug-binding proteins; therefore, some experts recommend starting a medication at one-half of the regular dose and titrating slowly. In contrast, pregnant women often require higher doses of medications because of larger volumes of distribution (Skånland, & Cieślar-Pobuda,2019).

SSRIs are off-label and prescribed for the treatment of bulimia nervosa leading to trials to evaluate their effect on binge eating disorder. Antidepressants that have shown promising results include 
bupropionLinks to an external site.
duloxetineLinks to an external site.
escitalopramLinks to an external site.
fluvoxamineLinks to an external site., fluoxetine, imipramine, 
sertralineLinks to an external site., and 
venlafaxineLinks to an external site..  

lisdexamfetamineLinks to an external site.
, a 
prodrugLinks to an external site. of D-amphetamine, is the only FDA-approved medication for binge eating disorder and should, as a rule, be preferred over antidepressants.

A nonpharmacological intervention for treating peripartum depression is psychotherapy. Nonpharmacologic treatment strategies are similar to prevention strategies, with the U.S. Preventive Services Task Force recommending referral for psychotherapy as the mainstay of treatment. Cognitive behavior therapy and interpersonal psychotherapy are the best studied and have the most robust supporting evidence. Group and individual approaches are effective. The two most common psychotherapies include interpersonal therapy (focus on improving social interactions and coping skills) and cognitive behavioral therapy (focus on adjusting patients' self-detrimental thought processes). Interpersonal therapy has been shown to improve mood during pregnancy, but cognitive behavioral therapy has only been validated for postpartum depression (Spinelly, 2003).

·
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Risks of medication use during pregnancy and breastfeeding must be weighed against the risks of untreated or inadequately treated depression. Inadequately treated depression has the potential to progress to active suicidality and can lead to impaired bonding for the birth parent, impaired childhood development, and adverse pregnancy outcomes, including preterm birth, low birth weight, and hypertensive disorders. Paroxetine might be associated with major malformations, especially cardiac defects. Some evidence is available of an association between neonatal behavioral syndrome and exposure to SSRIs in utero during the last trimester. Infants with continuous exposure to mother's depression and continuous exposure to SSRIs throughout gestation were more likely to be born preterm than were infants with partial or no exposure. Guidelines suggest that SSRIs should be used with caution during pregnancy, and that paroxetine be avoided (Kupfer, Frank & Phillps, 2012).

·
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

·
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Consistent with the goals of the new FDA and Pregnancy and Lactation Labeling Rule, clinicians must consider the risks of untreated illness as well as pharmacotherapy-related maternal adverse reactions, infant outcomes, and birth complications when counseling patients about medications in pregnancy and postpartum. Discussion of dosing requirements during gestation and any adverse effects related to breastfeeding must also be addressed (Betcher et al, 2019). Nurse practitioners and others who prescribe these drugs need to be aware of potential adverse effects and counsel depressed pregnant women appropriately. Some of the possible risks are drug perfusion to the fetus, adverse birth outcomes, neonatal withdrawal syndrome, and impaired child development. Before nurses can help to treat depression, they must first be able to recognize it. To screen for depression, it is important to be clear about the definition, risk factors, and comorbidity of depression in pregnant women.

SSRI antidepressant use in the final trimester also has been associated with 

persistent pulmonary hypertensionLinks to an external site.
 in the newborn. Researchers utilizing the Medicaid Database with nearly 3.79 million pregnant women compared outcomes of women taking an SSRI, another class of antidepressant, or no antidepressant in the last 90 days of pregnancy. Pregnant women who discontinued their antidepressants proximal to conception were nearly three times more likely to suffer a recurrence of depressive symptoms during pregnancy than women who continued their medication. Small case series studies show that the concentrations of the SSRI 
fluoxetineLinks to an external site.
sertralineLinks to an external site.
citalopramLinks to an external site., and 
escitalopramLinks to an external site. decrease throughout pregnancy. Doses may need to be adjusted for pregnant women taking SSRIs. Monitoring symptoms frequently, especially in the second and 

third trimestersLinks to an external site.
, and 

dose increasesLinks to an external site.
 with early symptoms of relapse is a strategy to avoid symptom recurrence (Ververs et al, 2009).

 

Replies week 7 MSN 5550

  Reply to  these posts with a reflection of their response.Minimun 200words each one 

1. In this week’s discussion, I was able to: Integrate nursing and related sciences into the delivery of care to patients. I was also able to analyze quality initiatives to improve patients’ health outcomes.

     Alternative and Complementary medicines are considered health-cultured practices, that are not part of traditional medicine and that have been part of the holistic culture of the populations. They are used as an alternative or in addition to traditional medical treatments with the goal of improving patients’ outcomes (Lee, Richard, et al., 2022). Alternative and Complementary medicines can include therapies such as dietary supplements, herbs, acupuncture, Chinese medicine, yoga, reiki, ayurvedic medicine, complementary supplements, etc (Adeniyi, Washington, et al., 2021). The reasons for using these alternative methods can be many: Cultural, religious, economic, etc. However, as many people use it most of the time, it is important to analyze this point and share our opinion on this matter.

     It is well-known that many people from the general population are used to taking self-prescribed natural treatments. In the first term, we can name herbal medications. In general culture and even in religion, people believe that herbs have a good effect in the treatment of some diseases such as hypertension or Diabetes Mellitus. Many people think that herbs were created by God in order to provide natural treatment for diseases. Actually, many people believe that herbal medicines are better choices as they don’t have undesirable effects at all. Some people prefer to take natural medication rather than medical treatments, as they think that pharmacological preparations are made of chemical and artificial ingredients that can be harmful to the body. Moreover, people trust natural treatments for cancer, as it is thought that they can potentially inhibit oncology cell growth. However, researchers have determined that about 80% of the patients do take their pharmacological treatment in addition to a natural treatment (Adeniyi, Washington et, al. 2021). However, there are some natural treatments that, in addition to pharmacological treatment, can cause adverse effects, for example, ginkgo can increase the anticoagulant effect; ginseng and some teas can decrease the anticoagulant effect (Izzo 2005). Other natural treatments such as exercises, meditation, yoga, and acupuncture, are also used and well-known as coadjuvants to release stress and that way help improve clinical condition.

     In conclusion, the healthcare team needs to accept that alternative and natural treatments are part of the culture and religion of the population. So it is very important to establish a good and trustable relationship with the patient, so he/she can feel confident enough to tell the healthcare provider about the alternative treatments that are been taken, as sometimes they can help, but sometimes they can be harmful. In the end, a closed and trustable relationship with the patient and a good assessment is the basis for the best possible outcomes.

2. The allopathic or conventional medicine is practiced by doctors and health personnel. Complementary medicine refers to the practice of medicine that complements conventional medicine, that is, it is used in conjunction with conventional medicine. An example includes the use of acupuncture in pain management. Alternative medicine, on the other hand, is the use of complementary and alternative medicine as a replacement for traditional medicine

Complementary and alternative medicine are very varied. Within them, we find natural products related to botanical medicine and probiotics. We also find mind and body therapy, such as meditation techniques, yoga, acupuncture, hypnotherapy, and deep relaxation exercises, among others.

In the treatment of cancer, it has been proven that the use of complementary and alternative therapy has been useful in managing the patient’s symptoms. However, it is not considered a miraculous medicine in the cure of cancer; it simply helps, in conjunction with conventional medicine, to manage some symptoms that cancer patients experience. For example, acupuncture treatment can help alleviate symptoms related to pain, therapeutic massages have been shown according to some research studies to reduce depression, pain, and depressive anxiety disorders related to cancer disease (American Cancer Society, 2019). However, some harmful health effects and interactions with medications have been shown, especially in treatment with botanical medicine, so it is recommended that your doctor be notified of its use before starting treatment to avoid drug interactions and potential harm to health (American Cancer Society, 2019).

Holistic medicine, unlike conventional medicine, is not focused on treating diseases as allopathic medicine does. Rather, it is preventative medicine, although it can be integrated with allopathic medicine in some instances. Holistic medicine is based on the fact that illnesses appear as a consequence or result of environmental, physical, social and/or emotional imbalances (Cannon, 2023). Therefore, its essence is to heal the body and mind with alternative therapies to maintain their balance and prevent the onset of illness. Holistic medicine dates back to ancient times, and after the appearance of conventional medicine, it was somewhat abandoned. However, in around the 1960s in Europe and America, the properties of holistic medicine regained popularity. An example of this is homeopathy, which can be used to recover body vitality as holistic medicine, but it can also be used as an adjunct treatment to allopathic medicine. The use of phytotherapy has had great success in the management of certain diseases, such as those of the immune system, favoring healing.

In the management of high blood pressure and diabetes, the practice of natural medicine plays a fundamental role as an adjunct to integrated medicine; even natural medicine can be used as a technique for the prevention of these diseases. The practice of a balanced and healthy diet, daily physical exercise, relaxation techniques and stress management are determining factors in the prevention of arterial hypertension, cancer, and diabetes. Other natural medicine can be used, for example omega 3 is an essential oil that can be used to prevent special hyperlipidemia in patients with chronic disease.

Both allopathic and holistic medicine have an important role on patient care, and together, they can give the best result in the management of the disease. As a provider, we need to offer the patient different option to treat their condition, but we need to be respectful of patients’ autonomy in their decision.

Peer Response 2

Be sure to provide 2 APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.

****1 paragraph for each peer response and 2 citations.********

Please be sure to follow EACH AND EVERY BULLET POINT.

(TOPIC is based on the peer that’s being reviewed)

Please do not plagiarize nor reword another person’s assignment that has been previously submitted.

Look at the attachment for responses that are needed!!!

Human Nutrition

 

Reading and understanding food labels can often feel like having to understand an entirely new language. However, it is important that consumers are able to read and interpret the nutrient content in the foods they consume.

For this assignment, you will need to compare the nutrition labels (provided) for two types of crackers, and then answer a series of questions. Use the Food Label Worksheet below.

File: 

Food Label Worksheet 

case study 6

2

Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety

Middle aged male

 

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Paxil 10 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

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Pathophysiology

  

Anemia and clotting disorders are common features of alcoholic liver disease. What are the mechanisms that cause these hematologic disorders?

GLOBAL HEALTH

Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues. 

Resources within your text covering international/global health, and the websites in the topic Resources, will assist you in answering this discussion question.

EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS

EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

· Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

· Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.

· Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.

· Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.

· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

LEARNING RESOURCES

Required Readings

· Melnyk, B. M., & Fineout-Overholt, E. (2023). 
Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

· Chapter 2, “Asking Compelling Clinical Questions” (pp. 37–60)

· Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 62–104)

· Davies, K. S. (2011). 
Formulating the evidence based practice question: A review of the frameworksLinks to an external site. for LIS professionals. 
Evidence Based Library and Information Practice, 6(2), 75–80.

· Library of Congress. (n.d.). 

Search/browse help – Boolean operators and nestingLinks to an external site.

. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

· Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). 
Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.Links to an external site. 
American Journal of Nursing, 110(3), 58–61.

· Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).
Evidence-based practice: Step by step: Igniting a spirit of inquiryLinks to an external site.
.Links to an external site. 
American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58

· Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). 
Evidence-based practice step-by-step: Searching for evidence.Links to an external site. 
American Journal of Nursing, 110(5), 41-47.

· Walden University Library. (n.d.-a).
 

Databases A-Z: NursingLinks to an external site.

. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

· Walden University Library. (n.d.-c).
Evidence-based practice research: CINAHL search helpLinks to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

· Walden University Library. (n.d.-d). 

Evidence-based practice research: Joanna Briggs Institute search helpLinks to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

· Walden University Library. (n.d.-e). 

Evidence-based practice research: MEDLINE search helpLinks to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

· Walden University Library. (n.d.-f). Keyword searching: 
Finding articles on your topic: Boolean termsLinks to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean

· Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: 
Introduction to keyword searchingLinks to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics

· Walden University Library. (n.d.-h). 

Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?Links to an external site.
 Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

· Walden University Library. (n.d.-i). 

Systematic review.Links to an external site.
 Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654