Critically Appraised Topics
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Item Utilizing the Marburg Heart Score for Early Recognition of Chest Pain in an Urgent Care Clinic: A Quality Improvement Project(2023-08-02) Koger, StephanieBackground/Problem: A challenging and concerning complaint presenting to any health care practice is chest pain. Chest pain is a ubiquitous complaint that accounts for 8-10 million emergency department visits and 1% to 3% of all primary care visits in North America annually. Urgent care clinics provide another option for patients seeking care for chest pain. However, there is currently no standardized protocol or uniformed practice recommendations for urgent care facilities to care for chest pain complaints. This void can create a barrier to prompt recognition and appropriate triage decision of chest pain in an urgent care clinic. Purpose: To develop and implement an evidence-based protocol for promptly recognizing and triaging a patient in an urgent care clinic over an 8-week period. Methods: The population for this project was patients over the age of 18 years presenting to an urban Midwest urgent care clinic with chest pain complaints. A clinical form and checklist were developed to assist in determining a level of risk to promptly aid nurses and providers in next steps such as waiting their turn in lobby, triaging them back to exam room with electrocardiogram, and/or sending them to the emergency department. Clinic registered nurses received education regarding the use of the protocol and involvement of the healthcare providers’ instruction and feedback. Findings/Results: A total of 18 patients with chest pain completed the scoring form; of those, six patients were sent to the emergency department via private car or ambulance. The final data showed positive feedback as well as early recognition of an acute coronary emergency. There was a statistically significant difference in the wait times when comparing pre-intervention and post-intervention data. Implications for Practice: Potential benefits include a timelier decision-making process due to earlier recognition of what needs to be triaged and sent to the emergency department. Patients benefit from a consistent, standardized, and punctual procedure used by providers and staff to assist in early recognition of a cardiovascular emergency versus a stable, intermittent chest pain that can be managed in urgent care. - No Thumbnail Available
Item What is the effectiveness of peer mediated intervention for children with autism spectrum disorder on increasing their social participation?(2024-05-11) Flippo, Olivia; Kugel, Lindsay; Schmit, EmilyABSTRACT BACKGROUND: Autism spectrum disorder (ASD) is a developmental disability that occurs in 1 per 36 children. Children with ASD may have signs and symptoms including problems with social communication and restrictive or repetitive behaviors or interests. These implications can impact their ability to engage in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) such as mealtime, dressing, school, work, and social participation. AIM: This critically appraised topic (CAT) is aimed at determining the effectiveness of peer mediated intervention (PMI) for children with autism spectrum disorder (ASD) on increasing their social participation. METHODS: Literature search analysis led to the inclusion of Level 1B and 2B studies regarding the prioritized aim. Studies were further analyzed to include literature within the last seven years which met the following outlined criteria: children with ASD participating in peer-mediated interventions to increase social participation. Six total studies were included which met the established standards. RESULTS: Level 1B and 2B research completed on PMI has revealed moderate, positive evidence regarding the effectiveness of PMI on increasing social communication, social skills, problem-solving skills, confidence in the work environment, and independence in ADLs/IADLs in school-aged children diagnosed with ASD. Further RCTs with larger sample sizes and systematic reviews should be completed to increase strength of evidence for PMI. - Loading...
Item Effectiveness of Sensory Integration Therapy on Functional Performance for Children With ASD(2023-05-08) Barajas, Rebecca; Estrada, Guadalupe; Sanchez, ElizabethABSTRACT: Autism Spectrum Disorder (ASD) is a complex developmental disorder which is increasing in prevalence as 1 in every 68 children aged eight are currently being diagnosed with ASD (Kashefimehr et al., 2018). The World Health Organization (2022) has reported the global incidence of ASD to be about 1.0%. Children with ASD can cause significant social, communication, and behavioral challenges. There are varying abilities of children and people with ASD. These children can have problems with social communication, and restricted or repetitive behaviors, making it difficult to engage in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as feeding, dressing, cleaning, and household chores. It is common for children with ASD to have a dysfunctional or dysregulated sensory system. Body awareness, motor skills, and balance can be affected by the inability to process sensory information. The purpose of this analysis was to critically appraise the effectiveness of sensory integration therapies to address sensory symptoms and improve functional performance and participation in children with ASD. The analysis demonstrated that occupational therapists can provide individualized treatment to address sensory challenges and promote engagement in daily activities. Using the principles of Ayres-SI, interventions can target sensory and motor difficulties to ensure safety and independence. This approach requires further research to establish a protocol that can be replicated as well as conducting research with a bigger sample size and more diversity in the participants. - Loading...
Item The Effectivness of Cognitive Behavioral Therapy on Sleep Performance and Emotional Regulation in Individuals with Traumatic Brain Injuries.(2023-04-21) Dueland, Nicole; Metcalf, Paige; Rogers, ClaireBackground: Occupational therapists can work independently or as part of a multi-disciplinary team to assess and treat a client following a traumatic brain injury (TBI). TBI is a significant public health problem affecting civilians, athletes, and military personnel as a result of motor vehicle accidents, falls, contact sports, assaults, and explosions (Aoun et al., 2019). It is estimated that 1.5 million people in the United States suffer from a brain injury every year (Aoun et al., 2019). A TBI can affect a variety of physical, cognitive, and psychological functions, such as sleep hygiene, fatigue management, motivation and planning strategies, and behavioral management. It is estimated that sleep disorders cost the United States $94.9 billion annually (Huyett & Bhattacharyya, 2021). Decreasing sleep disorders in individuals with a TBI can increase all aspects of an individual's life and can reduce expenses of additional healthcare and pharmaceutical drugs. Occupational therapists can help regain the skills and provide education to help clients progress towards participating more fully in activities of daily life (Potter et al., 2016). AIM: This CAT is aimed at determining the effectiveness of Cognitive Behavioral Therapy (CBT) on sleep performance and emotional regulation for individuals with Traumatic Brain Injuries. METHODS: Level I and II randomized control studies were analyzed and included in the CAT if they published in the last 8 years, included participants with a history of TBI, interventions contained elements of CBT, and outcome measures included sleep or fatigue. RESULTS: Level I and II research completed on CBT interventions has revealed effective for decreasing symptoms of anxiety, fatigue, and sleep performance associated with TBI. - No Thumbnail Available
Item What is the Effectiveness of Constraint Induced Movement Therapy (CIMT) on Improving Upper Extremity Function for Children With Cerebral Palsy?(2023-04-20) Butler, Ally; Gleason, Lauren; Tymus, CourtneyCerebral palsy (CP) is the most common childhood disability, with three of every 1000 births being a child with CP. Currently, 500,000 children under the age of 18 have CP. A diagnosis of cerebral palsy can affect body movement, muscle control, muscle coordination, muscle tone, posture, fine motor skills, and gross motor skills. CIMT is an innovative method of upper extremity rehabilitation for children with neuromotor impairments, such as cerebral palsy. The purpose of this analysis was to critically appraise the use of CIMT on upper extremity function for children with CP. This analysis showed that CIMT may be an effective treatment method for significant improvement in upper extremity function for children with hemiplegic CP. Further investigation is needed to determine the most effective protocol and treatment duration for CIMT.