NURS 5321 Research Methods and Statistical Analysis Paper

Literature Review

Postoperative nausea and vomiting (PONV) is a condition that typically happens after some hours after surgery significantly during the initial 24 hours. It has the ability to cause serious mortality, extended hospital admission, and higher medical expenses. It may be secured or managed before or during surgery. PONV affects around 25 to 40 % of surgery patients, and clients with identified risk effects are more prone to get it. Research has confirmed that a variety of variables lead to PONV, including the method of anesthesia and procedure utilized, the patient's propensity to nausea and vomiting, medicines given pre and post-surgery, the utilization of volatile anesthetics, the usage of prescription drugs pre and post-surgery, and age, with individuals aged 6 to 16 becoming the most susceptible. . More study is needed to evaluate if PONV can be handled with non-pharmacological approaches including fasting, increasing oral fluid intake, and taking carbohydrate-rich drink before and after surgery to avoid the issue from emerging. In adult rehabilitation patients undergoing procedures requiring anesthesia, will best practice recommendations for pre-procedure and pre-surgical fasting compared to nothing by mouth at midnight fasting prior to a procedure decrease the incidence of nausea and vomiting during their inpatient encounter?. This is the PICOT question that will be answered by identifying the research methodology, literature analysis, and domains of more research that surround the resolving of PONV NURS 5321 Research Methods and Statistical Analysis Paper.

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Search History

To construct an excellent PICOT question, one must perform detailed analysis and apply precise parameters to truly determine what techniques are useful for this PICOT. Searching the internet for credible and peer-reviewed studies that somewhat reflected the PICOT question was a half-battle. It was crucial to differentiate between websites that are considered to be inaccurate, including Wikipedia, during this step. The application of Google Scholar was vital to both the performance of matching sources. The usage of main terms or key words significantly narrowed the research outcomes, which was the key to enhancing the research results. In additional to identifying pertinent articles, researchers used a range of analysis approaches, including subjective, quantitative, and research architecture, to shed more light on the PICOT formulation. The key terms include PONV, nausea, vomiting and fasting. The study incorporated ten quantitative scholarly articles.

Literature Review

A study by Kim et al. (2018) aims at prospectively evaluating the occurrence of vomiting and nausea after access to non-ionic low-osmolality, as well as possible risk indicators with an emphasis on regular food and fluid fasting period. The sample size comprised of 1175 patients undergoing CT with contrast, no control group or randomization. The research design includes study of patients undergoing same treatment. No randomization or no control or comparison group. The independent variable is the consumption of a CHO drink, placebo drink, or nothing by mouth while the independent variable is the incidence of PONV. With categorical data, the Fisher ’s exact test awas used, and for response variable, the separate t-test or Mann–Whitney test was used. P-values smaller than.05 was deemed statistically important. In our sample group, which was advised to resist solid food for 6 hours before ICM-improved CT, moderate nausea prevailed in 2.9 percent of participants, and none vomited. There is no correlation between fasting time for both solid foods and liquids and the experience of vomiting and nausea NURS 5321 Research Methods and Statistical Analysis Paper.

`The study by Klemetti et al. (2009) aimed at assessing if more progressive oral fluid consumption can alleviate postoperative discomfort, nausea and vomiting in infant ambulatory colonoscopy. A total of 116 children aged 4 to 10 years old were included in the report, all of whom were experiencing ambulatory tonsillectomy or adenotonsillectomy. There were 58 participants in the action community and 58 people in the monitoring group. In two times, the infants in the intervention program consumed specific fluids. A controlled trial was employed as the technique. The Chi-squared method was used to equate variables between classes. The Shapiro–Wilk test was used to evaluate if the input variables were regular. The two-sample t-test was used to compare variations in naturally distributed parameters between classes or other dichotomic variables. The Mann–Whitney U-test was used to test the disparity between classes when the variables were not usually distributed. The Kruskal–Wallis test was used to investigate the associations between three groups of demographic factors and the discomfort and nausea of infants. Spearman's rank-order correlation analysis was used to measure associations. Statistical significance was described as a P-Value of less than 0.05. Shorter fasting periods decreased post-operative discomfort, but not PONV during the preoperative hours or 24 hours after surgery, according to the findings. Around four kids in the PACU reported nausea (VAS = 1–2), two in the monitoring group and one in the treatment group, and no one threw up coagulated blood. 19 children spat blood (22.4 percent /10.3%, respectively). The infants were not quite nauseous in the second step operating room, 2 hours after operation, according to the parents' and children's VAS ratings, but nausea was growing in both classes with no noticeable gap between them (p = 0.966, n = 105; p = 0.324, n = 68; respectively). According to all VAS ratings, the infants were the most nauseous four hours after operation. Over half of the kids puked, and the rest of them threw up blood NURS 5321 Research Methods and Statistical Analysis Paper.

In the article by Lin et al.( 2017), the goal was to determine the benefits and drawbacks of preoperative fluid consumption. Related articles written between 2003 and January 2017 were reviewed. Nine eligible papers from the 30 chosen articles were used in the study. The study model was a meta-analysis of "NRC, CINAHL, WOS, PubMed, Cochrane, UpToDate, DynaMed, NGC, Airiti Library search engines". A minimal to moderate dosage of fluid ingested 2 hours before operation did not dramatically raise the amount of gastrointestinal fluids during anesthesia with a combined effect of 2.37 (95 per cent CI [-5.12, 9.85], p =.54) and had little effect on gastric fluid PH with a cumulative effect of 0.10 (95 per cent CI [0.00, 0.20], p =.05). As a consequence, minimal volumes of liquid 2 hours before operation did not dramatically raise the level of gastric fluid or PH and lowered the likelihood of respiratory failure, GERD, post-op problems and decreased postoperative thirst and appetite. The research demonstrates the benefits of enabling patients to receive a moderate or lower dosage of liquid prior to operation to compensate for the drawbacks.

Hausel et al. (2005) performed another analysis to explore if a carbohydrate-rich drink (CHO) may assist with preoperative irritation. It was even proposed that it could assist with postoperative nausea and vomiting (PONV). A total of 172 elderly patients were included in the analysis, all of whom were scheduled for an endoscopic cholecystectomy. A randomized controlled experiment is included in this study. Fasting from dinner time, preparing with a placebo cocktail, or preparation with CHO were the three pre-operative therapy classes. The intake of a CHO drink, a substitute drink, or none by mouth is the independent variable, whereas the frequency of postoperative nausea and vomiting is the dependent variable. The chances of nausea and vomiting 12–24 hours after outpatient laparoscopy is greater in people who fasted nighttime than in those who obtained CHO, according to the study's findings. Furthermore, in the placebo and fasted categories, there was a substantial postoperative rise in nausea results relative to preadmission ratings, but not in the CHO community. PONV can be improved by CHO 12–24 hours after endoscopic cholecystectomy NURS 5321 Research Methods and Statistical Analysis Paper

Tran et al. (2013) looked into the impact of carbohydrate intake on insulin tolerance in patients that had undergone coronary artery reconstruction graft and spinal depressurization and fusion operation. In addition, ten well-being factors were measured. Nausea, discomfort, and hunger were among the factors. People receiving obstetric CABG surgery or multimodal (>1 interspace) spinal deceleration and fracture surgery were included in the study's sample population. Twenty-six people will receive a transcatheter aortic valve graft and twelve will have spinal surgery. The test design is a randomized controlled experiment. There were two groups: one that fasted and another that drank CHO. The median value for secondary result variables is seen (25th, 75th percentile). Numerical data were evaluated using the 2 test or the Fisher exact measure if the amount in either cell was greater than 5, and were represented as counts (percentage). P.01 was used to assess the importance of the results. Except for discomfort and hunger, no variations between groups were observed in the data for all other indicators of objective well-being.

The aim of Yilmaz et al. (2017)'s research is to assess the results of CHO given 2 hours preceding surgery versus postoperative fasting for 8 hours on preoperative depression gastric capacity and carbonation, PONV, and antiemetic drug intake in persons undertaking obstetric laparoscopic cholecystectomy. The research involved 40 participants from the American Society of Anesthesiologists (ASA) I-II that were between the ages of 18 and 60 who were eligible for an obstetric laparoscopic cholecystectomy. Around December 2008 to March 2009, a longitudinal, comparative, controlled analysis was performed. The predictor variables is CHO drink intake against fasting from midnight, whereas the dependent variables are nausea and vomiting intensity and antiemetics use. PONV ratings and antiemetic intake were found to be decreased with the usage of CHO beverages in the sample. PONV was contrasted between the CHO and fasting categories during the PACU time as well as 24 hours after a procedure using the Verbal Descriptive Scale (VDS). VDS scores were comparable between populations in the PACU phase, but VDS scoring were slightly less in the CHO group at 24 h, while antiemetic intake was larger in the fasting group.

Power et al. (2013) performed another analysis to evaluate if an evidence-based regimen for shortened preoperative fasting influenced fasting periods, patient protection, and comfort. The 21 clients who took part in the research adopted a preoperative fasting regimen that required them to ingest fluids and particles up to 2 and 6 hours before anesthesia. NPO was accompanied by 29 patients at nighttime. To examine the variations in means with each result evaluated, a test was used. Descriptive statistics are evaluated using Chi-squared analysis. Following the introduction of the fasting regimen, substantial decreases in fasting periods for fluids (p = 0.000) and solids (p = 0.000) were reported. Those that had a shorter fast recorded less preoperative fatigue (0.000), migraine (0.012), and discomfort (0.015). When opposed to the ‘control group,' the ‘short-fast group' recorded substantially less preoperative symptoms (thirst, headache, and nausea). As a consequence, the fasting procedure increased patient comfort.

In the article “Preoperative fasting guidelines” by Crowley (2019), the aim to provide rationale and recommendations of current evidence to provide a comprehensive guide on preoperative fasting to decrease the risk of aspiration and severity should it occur. The sample demopgraphic include healthy, pediatric, obese, pregnant, diabetic, tracheostomy and long-term enteral tube feeding patients. The study design and measurements were not mentioned in the article. The results showed that reducing preoperative fasting times to 6 hours for solids, 2 hours for only liquids; hours for breast milk, 6 hours for nonhuman milk, formula, and light meal,  8 hours for fried or fatty foods and meat seem to work effectively. Carbohydrate boost of liquid of 300-400 mL up to 2 hours before anesthesia, enteral tube feed without a cuffed tracheostomy tube stop 8 hours before the procedure suggests preoperative fasting of 2-8 hours depending on diet ingested.  Enteral feedings times are dependent upon pre-pyloric or post-pyloric tube placement NURS 5321 Research Methods and Statistical Analysis Paper.

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The article by Brady et al. (2003) seeks to review preoperative fasting regimens on complications and patient wellbeing. The sample population was 38 randomized clinical trials conducted 38 healthy adults. The study design used was meta-analysis and randomized control trials. Databases, workshop reports, and references from related publications were all included in the search. Participants who were offered a drink of water had a smaller gastric volume than anyone who adopted a traditional fasting procedure. There was no proof that the amount of fluid allowed during the preoperative phase (low or high volume) influenced results relative to those who adopted a norm quick. As opposed to the normal NPO from midnight fasting protocol, there was no indication that a shorter fluid fast raises the likelihood of aspiration, reiteration, or associated morbidity. Allowing patients to consume water prior to operation culminated in a substantial decrease in gastric volume.

A study by Noba & Wakefield (2019) seek to assess if oral preoperative carbohydrate liquids decrease hospitalizations, minimize insulin tolerance, and/or enhance postoperative irritation for individuals undertaking abdominal or cardiac operation by  investigating current findings. The study involved 22 RCTs for a cumulative sample size of 2,065, and 15 studies containing 1584 patients looking at the impact of glucose beverages on nausea and vomiting. Five sources were reviewed in a systematic analysis of randomized clinical trials (RCTs) (MEDLINE, EMBASE, CINAHL, British Nursing Index, and ASSIA). The Visual Equivalent Scale  as well as Verbal Informative Scale  is used to evaluate postoperative drowsiness . The research found some proof that a carbohydrate drink may alleviate nausea and vomiting episodes. Patients who did not drink within 2 hours of surgery had a rate of 270/5192 (5.2 percent), whereas clients who could drink it up to the surgical operation had a rate of 179/4724 (3.8 percent), an apportionment (95 percent confidence interval) of.73 (.61 to.88), P =.00074. Vomiting concentrations were 146/5186 (2.8%) and 104/4716 (2.2%), respectively, with a relative rate (95 percent CI) of.78 (.61 to 1.00), P =.05.

Strengths and Gaps of the Study

The articles offered a broad range of critical details to help direct the resolution of the occurrence of the PICOT problem. The main element with these tools was somewhat identical in that the study carried out was on a limited basis and could not be used to extrapolate the knowledge in the health sector. It will be necessary to carry out these testing methods on a larger scale in order to increase the reliability and authenticity of the results. Due to the individuality of each client, the unknown is the right approach that will tend to be the most successful in the care of PONV. The occurrence of the problem and the need to address PONV is known in this study.  These healthcare resources are disregarding the issue of PONV, but more study of PONV is needed in order to eradicate this concern and thus increase the standard of treatment.

Conclusion

Numerous researches have shown that the invention of new ideas would become gradually apparent as time progresses and more scholars become enthralled with the resolving of PONV. PONV has a huge effect on certain adults’ recovery, and while this subject does not apply to all, the reality is that PONV is not harmful, and everybody who has surgery is at danger for developing it. PONV does not have to be the subject of a patient's hospital visit, but the slight steps that healthcare professionals do to avoid PONV will make a significant difference in the overall success of each person experience NURS 5321 Research Methods and Statistical Analysis Paper.

References

Brady, M., Kinn, S., Stuart, P., & Ness, V. (2003). Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews(4). https://doi.org/10.1002/14651858.CD004423

Crowley, M. (2019). Preoperative fasting guidelines. UpToDate.

Hausel, J., Nygren, J., Thorell, A., Lagerkranser, M., & Ljungqvist, O. (2005). Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. British Journal of Surgery, 92(4), 415–421. https://doi.org/10.1002/bjs.4901

Kim, Y. S., Yoon, S. H., Choi, Y. H., Park, C. M., Lee, W., & Goo, J. M. (2018). Nausea and vomiting after exposure to non-ionic contrast media: incidence and risk factors focusing on preparatory fasting. The British Journal of Radiology, 20180107. https://doi.org/10.1259/bjr.20180107

Klemetti, S., Kinnunen, I., Suominen, T., Antila, H., Vahlberg, T., Grenman, R., & Leino-Kilpi, H. (2009). The effect of preoperative fasting on postoperative pain, nausea and vomiting in pediatric ambulatory tonsillectomy. International Journal of Pediatric Otorhinolaryngology, 73(2), 263–73. https://doi.org/10.1016/j.ijporl.2008.10.014

Lin, F.-T., Lin, T.-R., Liao, C.-W., & Chen, S.-H. (2017). A systematic review and meta-analysis of the pros and cons of consuming liquids preoperatively. Hu Li Za Zhi, 64(4), 79–88. https://doi.org/10.6224/JN.000057

Noba, L., & Wakefield, A. (2019). Are carbohydrate drinks more effective than preoperative fasting: A systematic review of randomised controlled trials. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.14919

Power, S., Kavanagh, D. O., McConnell, G., Cronin, K., Corish, C., Leonard, M., Crean, A., Feehan, S., Eguare, E., Neary, P., & Connolly, J. (2011). Reducing preoperative fasting in elective adult surgical patients: a case–control study. Irish Journal of Medical Science, 181(1), 99–104. https://doi.org/10.1007/s11845-011-0765-6

Tran, S., Wolever, T. M. S., Errett, L. E., Ahn, H., Mazer, C. D., & Keith, M. (2013). Preoperative Carbohydrate Loading in Patients Undergoing Coronary Artery Bypass or Spinal Surgery. Anesthesia & Analgesia, 117(2), 305–313. https://doi.org/10.1213/ane.0b013e318295e8d1

Yilmaz, N., Cekmen, N., Bilgin, F., Erten, E., Ozhan MÖ, & Coşar A. (2013). Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 18(10), 827–32. NURS 5321 Research Methods and Statistical Analysis Paper

This is an individual assignment consisting of a paper limited to 10 total pages, including a title page and reference pages. Provide an introduction for your paper. Provide your PICOT Question from Assignment 1. Provide a brief review of your search history to include terms used, and the number of articles located. Provide a Literature Review utilizing the ten articles you identified in Assignment 2. Identify the strengths and gaps noted in your review. Provide a Conclusion for your paper. At least ten references should be identified in the paper and references page. Use proper grammar/spelling/and APA format guidelines. Include an introduction and Conclusions section for your paper. This paper is limited to ten pages total, including your title page and references page(s). I will upload the evidence matrix and related papers that will help. All the references are listed in the matrix. Here is feedback on the matrix