A patient comes in through the emergency department. In this case, the patient would be triaged and seen in the emergency department. Think about what happens in an emergency area. The patient could be asked to change into a hospital gown (think about the costs of the gown and other supplies provided).

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A patient comes in through the emergency department. In this case, the patient would be triaged and seen in the emergency department. Think about what happens in an emergency area. The patient could be asked to change into a hospital gown (think about the costs of the gown and other supplies provided).

If the patient is displaying signs of vomiting, plastic bags will be provided and possibly antinausea medication. Lab work and possibly x-rays would be done. The patient could be sent to surgery, sent home, or admitted as an inpatient. If he or she is admitted as an inpatient, meals will be provided and more tests will be ordered by the physician—again, more costs and charges for the patient bill. Throughout the course, you will be gathering additional information through your readings and supplemental materials to help you write your white paper.

When drafting this white paper, bear in mind that portions of your audience may have no healthcare reimbursement experience, while others may have been given only a brief overview of reimbursement. The goal of this guide is to provide your readers with a thorough understanding of the importance of their departments and thus their impact on reimbursement. Be respectful of individual positions and give equal consideration to patient care and the business aspects of healthcare. Consider written communication skills, visual aids, and the feasibility to translate this written guide into verbal training.

Specifically, the following critical elements must be addressed:

I. Reimbursement and the Revenue Cycle

A. Describe what reimbursement means to this specific healthcare organization. What would happen if services were provided to patients but no payments were received for these services? What specific data would you review in the reimbursement area to know whether changes were necessary?

B. Illustrate the revenue cycle using a flowchart tool. Take the patient through the cycle from the initial point of contact through the care and ending at the point where the payment is collected.

C. Prioritize the departments at this specific healthcare organization in order of their importance to the revenue cycle. Support your ordering of the departments with evidence.

Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).

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Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).

In a written paper of 1,200-1,500 words, apply the concepts of epidemiology and nursing research to a communicable disease.

Communicable Disease Selection

Choose one communicable disease from the following list:

Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV

Epidemiology Paper Requirements

Include the following in your assignment:

Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence).
Describe the determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).
Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.

A minimum of three references is required.

Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

My school uses Turnitin.

Textbook: Community/Public Health Nursing Practice: Health for Families and Populations

Read Chapters 5-8.

The Role of the Nurse in Interdisciplinary Rounds

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The Role of the Nurse in Interdisciplinary Rounds

Historically the role of the nurse has been as a patient advocate. Nurses’ have advanced from being seen as low cost labor to an autonomous practioner. Prior to Florence Nightingale the nurse was a member of a religious order or under the direction of the military. Florence Nightingale established the first nursing schools and was responsible for their own practice. In the early 1900’s nursing education was taken over by hospitals and the licensing of nurses began. In the 1990’s nurse practioners, (under the license of a physician), began prescribing medications, ordering lab and radiology test, and referring patients to other health care providers (Nursing: history of nursing, 2012).

A patient having renal surgery suddenly develops massive hypertension and dies during surgery. An autopsy shows the presence of a pheochromocytoma. In your own words, explain how this incident might have happened.

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A patient having renal surgery suddenly develops massive hypertension and dies during surgery. An autopsy shows the presence of a pheochromocytoma. In your own words, explain how this incident might have happened.

Your favorite cousin, who is 20 years old, has just been diagnosed with type 2 diabetes. He is overweight and spends most of his time playing computer games or watching television. As a health professional, what advice will you give him?

Your patient has just been diagnosed with SIADH. His mother is asking you what this condition is and what she should expect next. What will you tell her?

Your patient has been admitted to the hospital in preparation for a total removal of her thyroid gland to reverse her hyperthyroidism. She suddenly develops thyroid storm. What manifestations will you find, and what is the pathophysiologic basis of thyroid storm?

Discuss how the availability of disease management, training programs, and a nursing hotline might help with health benefits costs.

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Discuss how the availability of disease management, training programs, and a nursing hotline might help with health benefits costs.

Describe the nature and components of, and the issues currently facing, executive compensation in various U.S. industries.
Discuss how the availability of disease management, training programs, and a nursing hotline might help with health benefits costs.
Discuss the compensation philosophies and approaches that have been used at organizations where you have worked. What have been the consequences of those philosophies and approaches?

Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

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Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Let’s have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion.

The diversity movement suggests that there is strength in our differences and that our differences enhance each other. At the same time, the movement insists that our differences should not have economic, social, or political consequences. We are entitled to the same access to resources and opportunities regardless of our differences. The human suffering from Hurricane Katrina and the images of victims has stimulated the debate about differential access to resources.
Read the report Women in the Wake of the Storm: Examining the Post-Katrina Realities of the Women of New Orleans and the Gulf Coast. On the basis of your reading, create a report, answering the following:
• Discuss the prominent dimensions of diversity revealed as a result of the Hurricane Katrina disaster.
• Discuss factors that specifically influenced women’s vulnerability to Hurricane Katrina. While answering, consider the primary dimensions mentioned in the lectures as well as the secondary dimensions such as parental and marital status, income, educational level, military experience, geographic location, work background, and religious beliefs.
• Describe the implications for healthcare organizations as a result of the disaster.
• Discuss at least of two of the policy implications that are outlined in the report. If you were given the task to add another policy recommendation what would it be and why?

Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Health Care Ethical Legal Conflict: Case Study

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Table of Contents (jump to)


Introduction


Choices in front of doctors


Futuristic impact of the decisions in such situations


Guidelines and code of conducts in medico-ethical conflicts


Principals followed for such cases


Implementation of guidelines and principals in current case


Conclusion


References

1. Introduction

In the present case study there is an ethico-legal arise when doctors have to perform treatment of chronic obstructive pulmonary disease (COPD) by which Mr. Con is suffering but his son (who has the authority to decide on behalf of Mr. Con) is adamant on no treatment for COPD. An ethical concern is a condition or crisis that calls for an individual to choose among two alternatives. It is very important that the present day medical physicians have continuing ethico-legal education (Preston-Shoot, McKimm, Kong, & Smith, 2011). Ethics is believed a standard of conduct and an idea of right and wrong beyond what the lawful consideration is in any particular situation. Moral assessments serve as a basis for ethical manner. Doctors have a legal responsibility to obey with the appropriate ethical and legal guidelines in their routine practice. Ignorance of regulation and its insinuations will be detrimental to the physician even though he takes care of the patient in good belief for the mitigation of the patient’s pain. In the present case study we are discussing the case of Mr. Con, who was suffering from chronic obstructive pulmonary disease (COPD) and now in condition that he cannot make his own decision. His son is representing his case about whether Mr. Con should give treatment for chronic obstructive pulmonary disease or not. The whole discussion in this essay will be based on this kind of ethico-legal issue.

2. Choices in front of doctors

In this case doctors do not have any choice other than legal option because all acts that are done in fine spirit may not stand legal testing. There are various ethical legal issues which can come forward if doctors refuse to consider the decision of Mr. Con’s son and treatment the COPD. As Mr. Con is suffering from multiple ailments so there are less chances that Mr. Con will survive. According to present condition, doctors can be framed for unauthorized treatment, and if proved then for murder also. With the rising figure of cases filed by hurt patients looking for legal remedy from physicians and medical organizations, it is no longer a subject of choice, but a context-driven lawful consent and requirement for the physicians to be acquainted with essential legal concerns involved in health practice. Professionalism is a subjective idea that refers to doctor performance in the place of work and within his area, and how it makes other public look at you (Doyal, 1999).

Some actions that doctors would take in condition of Mr. Con can be ethical in the view of one group of experts might make look puny in the views of others. Considering the lawful and ethical consequences of doctor conduct will help to make a decision what heights of professionalism we want to uphold in different circumstances (Rogers & Ballantyne, 2010). Medical ethics is a very important part of health practice, and following ethical rules is a vital part of your occupation. Ethics deals with common principles of correct and incorrect, as opposed to obligations of law. A professional is anticipated to act in ways that reveal society’s thoughts of right and wrong, even if such conduct is not imposed by law. Often, though, the law is based on ethical concerns. In the present case physicians should think to treat Mr. Con for COPD despite of consent of his son.

Practicing suitable professional ethics has an optimistic impact on your repute and the accomplishment of your employer’s trade (PrestonShoot & McKimm, 2011). Many medical associations, therefore, have generated guidelines for the adequate and preferred modes and behaviors, or decorum, of medical assistants and doctors. The codes of medical ethics have expanded over time. The Hippocratic pledge, in which medical scholars pledge to perform medicine morally, was developed in olden Greece. It is still used these days and is one of the bases of contemporary medical ethics. The Code of Ethics of the American association of medical assistants (AAMA) shall set 4th principles of ethical and moral manner as they relate to the health profession and the specific practice of medical supporting (Iqbal & Hooper, 2013).

3. Guidelines and code of conducts in medico-ethical conflicts

There are various guidelines which doctors should follow in the case similar to the present case of Mr. Con. The doctors must cautiously follow every state and federal practice rules and regulations while performing this treatment. They must follow the Code of Ethics for medical subordinates. It is an important part of their duty to avoid misconduct claim—court case by the Mr. Con’s son in opposition to the doctor for mistakes in cure.

To perform efficiently as a medical subordinate, the doctor must pursue all OSHA guidelines for safety, risky equipment, and poisonous substances (Knight, Sleeth, Larson, & Pahler, 2013). The place of treatment should meet quality control (QC) and quality assurance (QA) principles for all examinations, samples, and treatments. It is his accountability to follow HIPAA rules, to make sure Mr. Con confidentiality and privacy of his evidences, to entirely document patient management, and to maintain patient proofs in an arranged and readily available manner (Anthony, Appari, & Johnson, 2014). In the present case of Mr. Con, physician should follow the risk management which can be described as a technique of reducing possibility of liability during institutional practices.

4. Principals followed for such cases

If Mr. Con is able of providing knowledgeable consent, then his choice about cure, including non-treatment, should be considered. This is a customary plus enforceable legal standard and reliable with the ethical code of respecting the sovereignty of the patient.But in the present case, situation is totally different. Ethical methods work in a comparable mode to ethical codes, the exploit of which has obtained much consideration in recent times. There are significant limitations to the standards approach to ethics which relate evenly to ethical codes. The hypothesis is most remarkably described based on 4 codes: sovereignty, non-malfeasance, beneficence, and impartiality (Mason, Laurie, & Smith, 2013). These principles are observed as one of 4 tiers in a ladder of levels of study necessary for ethical rationalization. At the 1st tier there are meticulous decisions which are necessary at the 2nd level by moral laws. These in turn are necessary at the 3rd level by principles, and codes are lastly justified at the 4th level by more inclusive ethical hypothesis. Both, the method and applicability” of “principles” have been tested, as well as protected as a regular structure for biomedical ethics. On the other hand, even their strongest enthusiasts do not see standards as a total or self-standing connotes of establishing moral practice. Beauchamp & Childress clarify that: “Principles direct us to acts, but we still require assessing a condition and formulating a suitable reply, and this evaluation and reaction flow from character & guidance to the extent that from standards” (Petersson et al., 2012). Gillon then called this: “the 4 principles and scope” mode of biomedical ethics” (Gillon, 2012). In the case of Mr. Con, doctor should follow these principals and plan the treatment.

5. Implementation of guidelines and principals in current case

The content of common principles and regulations represents theories and worth’s that can locate the common ethical nature and approach for fitness care. Though, it is of small use in explaining personal ethical decisions. The insinuations for establishing ethical systems lie in recognizing their possible worth in describing the moral atmosphere and ethical approaches that are divided by health care employees. Regulations can also give clear sites for a few headline moral subjects for example euthanasia, but cannot give the convinced answers to a lot of ethical troubles encountered in the way of daily checkup practice. The purpose as to whether Mr. Con has theabilityto offer informed permission is generally an expert decision made and texted by the treating health care supplier. The provider can create a purpose of provisional or enduring inability, and that fortitude should be bonded to a particular verdict. The legal word competencymay be employed to explain a legal determination of supervisory capacity. The designation of a particularsubstitute choice makermay either be sanctioned by court regulations or is specified in condition statutes.

6. Conclusion

If a court has decided that a patient is lacking ability, a health care giver must acquire informed permission from the court-agreed decision-maker. For instance, where a protector has been selected by the court in a responsibility act, a health care giver would look for the informed authority of the custodian, provided that the applicable court arrange covers individual or health care executive. From the whole discussion, we can conclude that, first the doctors should seek legal opinion and the according to options they should plan the treatment. Doctor should try to make Mr. Con’s understand about the consequences if Mr. Con will not treat for COPD soon. If his son still remains adamant then doctor should follow the court decision and do the treatment accordingly. Doctor should follow medical code and conduct but that should be in range of law.

7. References

Anthony, D. L., Appari, A., & Johnson, M. E. (2014). Institutionalizing HIPAA Compliance Organizations and Competing Logics in US Health Care.

Journal of health and social behavior, 55

(1), 108-124.

Doyal, L. (1999). Ethico-legal dilemmas within general practice.

General practice and ethics: Uncertainty and responsibility

, 37.

Gillon, R. (2012). When four principles are too many: a commentary.

Journal of medical ethics, 38

(4), 197-198.

Iqbal, R., & Hooper, C. R. (2013). Ethico-legal considerations of teaching.

Continuing Education in Anaesthesia, Critical Care & Pain, 13

(6), 203-207.

Knight, J. L., Sleeth, D. K., Larson, R. R., & Pahler, L. F. (2013). An analysis of OSHA inspections assessing contaminant exposures in general medical and surgical hospitals.

Workplace health & safety, 61

(4), 153-160.

Mason, K., Laurie, G., & Smith, A. M. (2013).

Mason and McCall Smith’s law and medical ethics

: Oxford University Press.

Petersson, I., Lilja, M., Borell, L., Andersson-Svidn, G., Borell, L., Beauchamp, T. L., et al. (2012). To feel safe in everyday life at home: a study of older adults after home modifications.

Ageing and Society, 32

(5), 791.

Preston-Shoot, M., McKimm, J., Kong, W. M., & Smith, S. (2011). Readiness for legally literate medical practice? Student perceptions of their undergraduate medico-legal education.

Journal of medical ethics, 37

(10), 616-622.

Preston-Shoot, M., & McKimm, J. (2011). Towards effective outcomes in teaching, learning and assessment of law in medical education.

Medical education, 45

(4), 339-346.

Rogers, W., & Ballantyne, A. (2010). Towards a practical definition of professional behaviour.

Journal of medical ethics, 36

(4), 250-254.

Global Nutrition and Health Essay

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Global Nutrition and Health: Analysis of Argentina


1.








Typical Agricultural Practices

Argentina lies in the South American continent. It is still considered a developing country; however, Argentina is one of the leading countries in terms of agricultural products. According to OECD Directory of Trade and Agriculture, Ken Ash, Argentina is one of the key players in the global agricultural markets and has a potential to enhance its productivity growth sustainably (OECD, 2019). Over the past three decades, factors such as stable international prices, extensive arable land, and well-educated farmers have contributed to the remarkable growth of the country’s agri-food sector (OECD, 2019). They produce one of the leading global producers such as soybeans, sunflower seed oil, lemons, beef, and honey. The main products available for consumption include sugar cane, milk, soybeans, which have helped to reduce the rate of undernourishment to less than 5 per cent between 2014 and 2016 (FAO, 2017). Other products available for consumption are grapefruits, oranges, vegetables, mandarins in Buenos Aires. Also, due to the prevalence of the foot-and-mouth disease in the 1990s, Argentine beef has suffered ban in major markets leading to decreased exports and increased local consumption of meat (Donghi et al., 2019, p.21).

Wheat and cons are the main crops that are highly harvested in the areas where livestock farming is high such as La Pampa and Pampas of Buenos Aire’s territories and in the north. These crops are edible and valuable for export still; they are mainly produced to feed the livestock. As a result, this makes Pampas the traditional primary source of beef cattle, which is the most valuable export in the country (Donghi et al., 2019, p.20). Other crops that are grown in the Pampas region include sorghum, soybeans, and flax, but they are ranked behind corn and wheat (Donghi et al., 2019, p.20). Grapes are also leading and native crops that are produced in Northwest regions, which contributes to 90 per cent of grapes planted in the country. In the warmer areas of these provinces, they grow sugarcane, and citrus orchards. While grapes are used for making wine, sugarcane and citrus orchards are used as substitutes for sugar and hence mitigating the volatility risks in the sugar market (Donghi et al., 2019, p.20).


2.








Indicators of Wealth and Health


In 2018, Argentina suffered an economic recession because of the factors such as capital inflow reversals and currency inflow slowdown due to a record drought in the country (OECD2, 2019, p.2).  As a result, this has led to a decrease of the Gross Domestic Product (GDP current) from US$642.7 billion in 2017 to US$518.5 billion in 2018 (The World Bank Group, 2019). As a result, with a total population of 44,494,502 in 2018, the GDP per capita annual growth decreased by 3.5 per cent and hence indicating a deteriorating state of the standard of living in the country (The World Bank Group, 2019). This means that the GDP per capita decreased from US$14,591.86 to US$11,652.57 from 2017 to 2018, respectively (The World Bank Group, 2019). Besides, a significant number of Argentinians live in poverty. According to OECD2 (2019, p.3), approximately 27 per cent of residents live in poverty, while 5 per cent lives in extreme poverty with the 2018 recession estimated to deteriorate the situation further. However, the national poverty headcount ratio has significantly declined from 30.3 per cent in 2016 to 25.7 per cent in 2017 (The World Bank Group, 2019).


Infant Mortality

: The number of infant deaths has significantly declined in the last ten years. For instance, the infant mortality in 2008 was 10185 deaths but, fell over the years to 6,934 deaths in 2018 (The World Bank Group, 2019).


Maternal Mortality

: In Argentina, the number of maternal deaths decreased from 420 deaths in 2008 to 390 deaths in 2015. The national estimate for maternal mortality ratio is 32.4 as per 2015 statistics. On the other hand, the lifetime risk for maternal death is 0.13 per cent as per 2015 statistics (The World Bank Group, 2019).


Life expectancy:

As per 2017 statistics, the life expectancy at birth for male was 72.96 years, while that for females was 80.44. The total life expectancy at birth is 76.74 years, which is higher than in many countries in South America. High life expectancy and low infant and maternal mortality have been the result of the vast numbers of health facilities in Argentina. Also, low cost of medical care due to various occupational insurance plans and control of diseases such as cholera, smallpox, tuberculosis, and yellow fever has contributed significantly to better health indicators in the country (Donghi et al., 2019, p.29).


3.








Key nutrition-related issues




i.














Nutritional deficiencies

Although there, I was not able to find data that shows supplementation of Vitamin A and consumption of iodized salt, the prevalence of diseases related to nutritional deficiencies illustrates that the country is affected by dietary deficiencies. For example, the rate of anaemia among pregnant women, non-pregnant women, women of reproductive age, and children in 2016 was 28.5%, 18.2%, 18.6%, and 22.2% respectively. Besides, Goetz and Valeggia (2016) conducted a study among 153 women in northern Argentina and revealed that 28 percent and 31 percent were anaemic and borderline anaemic, respectively. The study also found a negative correlation between the prevalence of anaemia and the consumption of vitamin C and Iron. For instance, “Women who consumed more iron and women who consumed more vitamin C in the past day were less likely to be anaemic than those who consumed less iron and those who consumed less vitamin C” (Goetz & Valeggia, 2016, p.4). This illustrates that nutritional deficiency of Vitamin C and Iron is a severe problem among women in Argentina.


ii.














Malnutrition

In a country that is among the largest producers of beef, protein consumption is expected to be high, indicating low chances of starvation. However, in 2005, the prevalence of stunting among children under five years was 8.2 per cent (The World Bank Group, 2019). Also, in 2016, the population of individuals experiencing undernourishment was 3.8 percent (The World Bank Group, 2019). This illustrates that malnutrition is not a severe problem in Argentina.


iii.














Obesity

In Argentina, overweight and obesity are growing concerns with more than two-thirds of the population. According to a report by the Fundación Interamericana del Corazón (FIC), around 66.1 percent of the adult population in the country are overweight (Shoup, 2019). The report suggests that 33.1 percent of this population are overweight, while 32.4 percent are obese (Shoup, 2019). This is because of the low intake of greens and fruits, in which only 6% of Argentinians meets the daily recommendation on the consumption of vegetables and fruits.


iv.














Breastfeeding

The most current record for breastfeeding shows that breastfeeding for children below six months is 32 percent in 2012. However, this was a significant decline from the previous year in which the exclusive breastfeeding was 52 percent (The World Bank Group, 2019).


v.














Food Insecurity

In Argentina, the food security issue has prevailed despite the measures employed by the government and the favourable food production index of 129.11 in 2016 (The World Bank Group, 2019). According to Pellettieri (2018, p.3), the food insecurity issues began in 2002, when the country announced a food emergence. Later in 2015, about 12.3 percent of the population was not guaranteed for adequate nutrient 2016, the cost of food in areas such as Buenos Aires hiked by 27 percent (Pellettieri, 2018, p.5). However, statistic shows that Argentina has excess food, but a massive amount of food goes into waste. For instance, discarded food in 2016 was approximately 9,500 tons (Pellettieri, 2018, p.4). Another reason that may help to explain the food insecurity issue in Argentina is the predominance of poverty.


4.








Recommendation

After this research, I believe that Argentina needs to change food habit not only to mitigate the food insecurity issue but also reduce the prevalence of conditions such as obesity. For example, societies should join hands in reducing the consumption of fatty oil and sodium salt. Besides, since the daily use of vegetables and fruits is low, nutritionists should create awareness and education programs to help Argentinians understand the importance of such food. Nutritionists and other stakeholders should also advocate and campaign for reduced salt intake to achieve the World Health Organization’s recommendation of 5 grams daily (Shoup, 2019, p.2). Since there is a correlation between food accessibility and poverty level, the Argentinian government and other stakeholders should employ extensive poverty elimination programs. Such a plan should aim at increasing the minimum wage, creating employment, and financing agricultural programs, among others.

In addition, to reduce nutritional deficiencies among children and women in the country, the government should support research and development to help increase the micronutrient content in raw materials and food. It is also essential to increase supplementation of vitamin C and consumption of iodized salt. Iron-rich foods that may be encouraged include fortified breakfast cereals, shellfish, liver, beans, spinach, broccoli, lean meats, and nuts, among others.

Argentinian government and other stakeholders should extend the programs for reducing food wastage in all corners of the country. The Ministry of Agriculture should broaden their training for local government, residents, and food producers to develop effective ways of reducing food waste. Such training should entail planning, checking the use-by dates, reducing over-buying, and adequate food storage mechanisms.


References

  • Donghi, T. H., Calvert, P. A., & Eidt, R. C. (2019). Argentina. In Encyclopedia Britannica (pp. 19-29). Retrieved from https://www.britannica.com/place/Argentina
  • FAO. (2017). Country Fact Sheet on Food and Agriculture Policy Trends: Argentina (I7752EN/1/08.17). Retrieved from Food and Agriculture Organization of the United States website: http://www.fao.org
  • Goetz, L. G., & Valeggia, C. (2016). The ecology of anaemia: Anemia prevalence and correlated factors in adult indigenous women in Argentina. American Journal of Human Biology, 29(3), 1-6.
  • OECD. (2019). Argentina’s agro-food sector is growing remarkably, but agriculture policies are not keeping pace. Retrieved from Organisation for Economic Co-operation and Development website: https://www.oecd.org/agriculture/news/argentina-s-agro-food-sector-is-growing-remarkably-but-agriculture-policies-are-not-keeping-pace-new-oecd-report-finds.htm
  • OECD2. (2019). OECD Economic Surveys: Argentina. Retrieved from Organisation for Economic Co-operation and Development Retrieved from:
  • http://www.oecd.org/eco/surveys/Argentina-2019-OECD-economic-survey-overview.pdf
  • Pellettieri, L. (2018). Food insecurity rising in Argentina, sparking protest and food-emergency bill. Global Press Journal. Retrieved from https://www.pri.org/stories/2018-06-20/food-insecurity-rising-argentina-sparking-protest-and-food-emergency-bill
  • Shoup, M. E. (2019, May 4). Obesity rates in Argentina on the rise as health organization calls for improved national food and nutrition policies. Retrieved from https://www.foodnavigator-latam.com/Article/2019/05/04/Obesity-rates-in-Argentina-on-the-rise-as-health-organization-calls-for-improved-national-food-and-nutrition-policies
  • The World Bank Group. (2019). Argentina. Retrieved from https://data.worldbank.org/country/argentina

Thoroughly discuss the theoretical rationale from your text or nursing literature that supports a minimum of two of the interventions that you applied in the care of your patient. Cite sources.

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Thoroughly discuss the theoretical rationale from your text or nursing literature that supports a minimum of two of the interventions that you applied in the care of your patient. Cite sources.

 

This is my draft, it is personal journal so is ok to use 1st person. All the INFORMATION from my draft should be used (kept), maybe only rewrite to make sound better. English is my second language so writing is my huge struggle.
Please check the body of the paper 4 pages. DO NOT worry about reference page and title page .
Make sure a journal is free of errors, grammar, and spelling mistakes.
Make sure paper is well organized with logical flow, also USE TRANSITIONS WELL.

PAPER STRUCTURE:
1. Introduction
a. Patient’s age, gender, medical and psychiatric diagnoses
b. The focus of your care plan or teaching plan
c. Purpose or thesis of the paper

2. Describe communication and collaboration strategies that you used to promote trust, build a therapeutic nurse-patient relationship, and establish professional boundaries. Identify nurse or patient factors that may have interfered with effectively relating with the patient or maintaining clear boundaries.

3. Discuss whether you experienced a conflict of values with the patient. Describe the strategies you chose to eliminate judgment of the patient’s choices or behaviors.

4. Identify assumptions, biases, or stereotypes that you may have experienced regarding the patient or their illness. Discuss feelings of frustration or discomfort that may have come up.
a. Examine the possible reasons for your beliefs and feelings and how you chose to manage them.
b. Describe how you demonstrated acceptance of the patient and their illness and the potential negative effect on the patient’s experience if you had not managed your thoughts and feelings

5. Thoroughly discuss the theoretical rationale from your text or nursing literature that supports a minimum of two of the interventions that you applied in the care of your patient. Cite sources.

6. Provide specific examples of how you thoughtfully and purposively demonstrated one or more of the Franciscan Values during your clinical shift. Discuss the impact on yourself and/or others. Cite sources.

7. Describe your intentional behaviors that depict professionalism and portray a positive image of nursing.

8. Evaluate your clinical performance by analyzing your professional growth. Identify areas in which you have developed more competence and areas in which you plan to improve.

9. Conclusion: instead if summarizing, conclude with how writing the journal was beneficial to you.

Benefits of Different Oxygen Levels Administered in ICU

/in /by


ABSTRACT:

There have been numerous studies conducted to identify the benefits of different oxygen levels administered in ICU (Intensive Care Unit) patients. However, the studies do not reveal a definitive conclusion. The proposed systematic review plans to identify if either conventional or conservative oxygen therapy methods is more constructive in critically ill adult patients who are admitted in ICU.


BACKGROUND

Oxygen therapy is a treatment that provides oxygen gas to aid breathing when it is difficult to respire and became a common form of treatment by 1917. (Macintosh et.al 1999). It is expended for both acute and chronic cases and can be implemented according to the needs of the patient either in hospital, pre-hospital or entirely out of hospital based on their medical professionals opinions. It was established as the most efficient and safest medicines required by the health system by World Health Organisation (WHO). PaO2 has become the guideline test for finding out the oxygen levels in blood. And by the 1980s, pulse oximetry method which measures arterial oxygen saturation was also progressively used alongside PaO2 (David 2013). The chief benefits of oxygen therapy comprise slowing the progression of hypoxic pulmonary hypertension, emotional status, cognitive function and improvements in sleep (Zielinski 1998). In UK, according to the national audit data about 34% of ambulance journeys involve oxygen use at some point while 18% of hospital inpatients will be treated with oxygen at any time (Lo EH 2003). In spite of the benefits of this treatment, there have been instances where oxygen therapy can negatively impact a patient’s condition. The most commonly recommended amount of saturation for oxygen intake is about 94-98%, and saturation levels of about of 88-92% are preferred for those at risk of carbon dioxide retention (BMA 2015).

According to standard ICU practice, the conservative method denotes that patients receive oxygen therapy to maintain PaO2 between 70 and 100 mm Hg or arterial haemoglobin saturation between 94-98% while conventional method allow PaO2 values to rise up to 150 mm Hg or SpO2 values between 97% and 100% (Massimo et al. 2016).There are also low flow systems where the delivered oxygen is at 100% and has flow rates lower than the patients inspiratory flowrate ( i.e., the delivered oxygen is diluted with room air) and, hence the Fraction of Inspired Oxygen(FIO2) may be low or high. However, this depends on the particular device and the patient’s inspiratory flowrate.


AIM

To investigate and conclude whether the use of a strict protocol for conservative oxygen supplementation would help to improve outcomes, while maintaining PaO2 within physiologic limits among critically ill patients.


RESEARCH QUESTION

A well- defined, structured and exclusive research question will lead as a guide in making meticulous decisions about study design and population and consequently what data can be collected and used for analysis.(Brian, 2006)

The early process of research for finding the research questions is a challenging task as the scope of the problem is bound to be broad. Significant time and care is needed to polish, extract and compare the information required from the vast sea of information (Considine 2015) .If a proper and specific research question is not formed, the whole process will be useless (Fineout-Overholt 2005). The fundamental success of any research project is attributed in establishing a clear and answerable research project that is updated with a complete and systematic review of the literature, as outlined in this paper. A PICO framework is a universally used framework used to develop a robust and answerable research question which is also a useful framework for assuring the quality or for evaluating projects. PICO stands for Problem / Population, Intervention, Comparison, and Outcome.

The research question presented in this paper is to identify whether conventional or conservative oxygen therapy methods is more beneficial among critically ill adult patients admitted in Intensive Care Unit.


LITERATURE REVIEW

The literature has focused on the effect of conservative and conventional oxygen therapy methods on mortality among patients in an Intensive Care Unit.

Although there have been several studies to analyse which of the two methods is more beneficial to critically ill patients, a definitive study which determines the mortality rate among the different categories needs to be analysed and investigated for its benefit.


Different devices used to administer Oxygen:

  1. Nasal cannula provides about 24-40% oxygen and flow rates up to 6L/min in adults (Fulmer JD 1984).
  2. A basic oxygen mask delivers about 35-50% FIO2 and can have flow rates from 5-10L/min depending on the fit and requirement of flow rate.
  3. The other respiratory aiding device is a partial rebreathing mask which has an additional reservoir bag with it which is also classified as a low flow system with flow rate of 6-10L/min and delivers about 40-60% oxygen.
  4. The non-breathing system is similar to the partial rebreathing mask, where it has an additional series of one way valves and it delivers about 60-80% FIO2 with a flow rate 10L/min.


Review and findings of different oxygen therapy studies:

A systematic review of two different published Journals indicated that the usage of additional oxygen when managing acute myocardial infarction arrived at the same result: that there is no significant benefit when oxygen therapy is administered while being assessed with air breathing (Cabello 2010) and it may in fact be damaging which results in greater infarct size and higher mortality rate (Wijesinghe 2009). Although a number of smaller studies could clarify the reviews, none of the original studies could reach a statistically substantial result ( Atar 2010); this stresses the need to provide data that validates the requirement for further analysis. Studies to support this have already been started, where The AVOID (Air Versus Oxygen In Myocardial Infarction) study is presently hiring patients to resolve this critical medical question (Stub 2012).Actual clinical trial data suggesting the effects of varied inspired oxygen levels are even more inadequate in acute ischemic stroke. It is proposed that oxygen therapy may be beneficial if administered within the first few hours of commencement, however it has also been observed that with continued administration, it may induce harmful results (higher 1-yr mortality) (Ronning 1999).

In a survey of group study where more than 6,000 patients were case studied following resuscitation from cardiac arrest , hyperoxemia ( defined as a PaO2 > 300 mm Hg (40 kPa),the results obtained were considerably worse than both normoxemia (60-300 mm Hg (8to 40kPa) and hypoxemia (PaO2<60mmHg(8kPa) (Kilgannon 2010).The authors of these article concluded that excessive oxygen has harmful potential during adult resuscitation post cardiac arrest, possibly via ischemic reperfusion damage to central nervous tissue. The data surrounding the link between arterial oxygenation, morbidity and mortality in critically ill patients is extremely restricted. The intricacy and challenge involved in this study relies on the successful separation of signal from noise among the group of heterogeneous patients. An independent study found evidence of low SaO2 among acute medical emergency admissions can also be an independent predictor of mortality (Goodcare 2006), however, this is more complex in established critical illness with persistent hypoxemia. Also the extent to which a reduction in arterial oxygenation can be tolerated in the critically ill is difficult to determine and remains tentative (Gothgen 2007).

There is also no robust proof for the postulation that an increased PaO2 is interrelated with improved long-term survival in critically ill patients( Young JD2000).A reflective study where more than 36,000 patients were considered and arterial oxygenation was administered while being mechanically ventilated, signs of a biphasic relationship was observed within a span of 24 hours between PaO2 and in-hospital mortality(De 2008).The average PaO2 level found was 99mm Hg, yet the foundation for unadjusted hospital mortality was just below 150mm Hg. A very similar study of more number of patients was conducted in Australia and New Zealand and this resulted in a report recording a mean PaO2 of 152.5mm Hg, indicating supraphysiological levels of oxygenation, with 49.8%of the 152,680 group was categorised as hyperoxemic PaO2>120mmHg(Eastwood , 2012). In contrast to the Dutch study, even though hypoxemia was associated with elevated mortality, after an adjustment of disease severity, a progressive association between progressive hyperoxemia and in-hospital mortality could not be linked together effectively. (Martin 2013).

The assumption that patients with hypoxemia secondary to ARDS (acute respiratory distress syndrome) respond positively to elevated arterial oxygenation reinforces many studies done in this field (McIntyre 2000). Nevertheless, data from clinical trials in patients with ARDS seem to disregard this assumption as frequent oxygenation and long-term outcome have a disconnection (Suchyta 1992). And the studies that report a correlation arterial oxygenation and mortality, a systemic review of 101 clinical studies in ARDS patients came to the conclusion that P/F ratio was not such a reliable predictor (Krafft 1996). Thus a more intense study was conducted to compare the supplementary oxygen therapy with no oxygen therapy in normoxic patients with ST Segment elevation myocardial infarction (STEMI). Oxygen therapy has been known to be only universally used for the initial treatment of patients with STEMI which is based on the belief that the additional oxygen may increase oxygen delivery to ischemic myocardium and hence reduce myocardial injury and is supported by laboratory studies done by Atar in 2010. The adverse effects of supplementary oxygen therapy were noted from a meta-analysis of 3 small, randomized trials as done by Cabello in the same year. More recently, another analysis was done by comparing high concentration oxygen with titrated oxygen in patients with suspected acute myocardial infarction which found no difference in myocardial infarct size on cardiac magnetic resonance imaging (Ranchord 2012). Hence, there are no studies that assess the effects of supplemental oxygen therapy in the setting of contemporary therapy for STEMI, specifically acute coronary intervention. With these reports and analysis put together, we can safely deduct that there remains a substantial amount of uncertainty over the usage of routine supplemental oxygen in uncomplicated Acute Myocardial Infarction, with absolutely no clear indication or recommendation for the level of oxygen therapy in normoxic patients in the STEMI guidelines. More recently, another analysis was done by comparing high concentration oxygen with titrated oxygen in patients with suspected acute myocardial infarction which found no difference in myocardial infarct size on cardiac magnetic resonance imaging (Ranchord 2012). The annual congress of European Society of ICU (2016) states that patients dying in the ICU was lowered by 9% while using conservative oxygen strategy as compared with the conventional one(JAMA 2016).


METHODOLOGY

Firstly the terms method and methodology needs to be differentiated. Method is a process used to collect and examine the data whereas methodology includes a philosophical inquiry of the research design as stated by Wainworth (1997). It is vital that the suitable methodology needs to be analysed in carrying out the research question and in assembling the data (Matthews 2010). Research Methodology is a way to find out the result of a given problem on a specific matter or problem that is also referred as research problem (Jennifer 2011). In Methodology, researcher uses different criteria for solving the given research problem and always tries to search the given question systematically in their own way to find out all the answers till conclusion. If the research does not work systematically on the problem, there would be less possibility to find out the final result. For finding or exploring research questions, a researcher faces lot of problems that can be effectively resolved while using a correct research methodology (Industrial Research Institute, 2010).

This research proposal was done under the systematic review method because it provides a very comprehensive and clear way of assessing the evidence (Chalmers 2001). Also it lowers error and bias and establishes a high standard of accuracy (Jadad, 1998). Healthcare providers, researchers, consumers and policy makers are overwhelmed with the data, evidence and information available from healthcare research. It is unlikely that the all this information is digested and used for future decisions. Hence a systematic review of such research will help to identify, assess and synthesize the information based on evidence needed to make those critical decisions. (Mulrow 1994). There are a number of factors for choosing systematic review for this study. A systematic review is generally done to resolve mismatched evidence, to verify the accuracy of current practice, to answer clinically unanswered questions, to find changes in practice or to focus for the need for any future research.

Systematic

reviews

[AD1]
are increasingly being used as a preferred research method for the education of post graduate nursing students (Bettany- Saltikuv, 2012). One of the best resources available on the conduct of systematic reviews of interventions is the Cochrane Collaboration (Tonya 2012). As defined by the Cochrane Collaboration (Higgins & Green,

2011

[AD2]
, Pg 6); ‘A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made’.

The aim of a systematic review is to incorporate the existing knowledge into a particular subject or regarding a scientific question (British Journal of Nutrition (2012). According to Gough et al (2012) a systematic review is a research method that is undertaken to review several relevant research literatures. Systematic reviews can be considered as the gold standard for reviewing the extensive literature on a specific topic as it synthesises the findings of previous research investigating the same or similar questions (Boland et al 2008). Using systematic and rigorous methods systematic reviews are often referred to as original empirical research because they review primary data, which can be either qualitative or quantitative (Aveyard & Sharp 2011).

Over the past years, various standards have been evolved for portraying systematic reviews, staring from an early statement called the QUOROM guidelines to an updated widely accepted statement called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al, 2009). While there are many differences in how each author approach a systematic review and there is no universal approach on one methodology for conducting review. However there are a set of fundamental set regarding the report of systematic reviews that authors are recommended to follow (Tonya 2012).



METHODS


SEARCH STRATEGIES:

The selection of relevant study is based on two concepts: sensitivity and specificity (Wilma 2016).The purpose of the literature search is to identify existing published research in the particular area of interest to assist the researcher to clarify and specify the research question, and to identify whether the research question has been answered. The search of the literature must be strategic and systematic, and informed by a documented strategy. Search strategies have two major considerations: search terms, and databases. Some of the most common and beneficial search strategies used in systematic reviews are using the database of Cochrane Central Register of Controlled Trials (CENTRAL), hand searching, Grey literature which contains unpublished studies, clinical trials and ongoing research on the trials. Contacting an expert and extracting information is another useful method. The internet provides access to a huge selection of published and unpublished database. Studies can also be found by referring the reference lists of the available published data.

The database that have been referenced in this paper have been searched, collected and for extraction from the vast base of

Northumbria

[AD3]
University accessible Journals. Journals from Medline, Ovid, ELSEVIER, PubMED and Cochrane Central Register of Controlled Trials, Journal of the American Medical Association( JAMA), newspaper articles from CHEST, Intensive Care Medicine ,CLOSE and ANZICS Clinical trial group, Resuscitation, Critical care journal, (all of the selected journals from the databases was validated as peer reviewed journals) were reviewed for this paper.


INCLUSION AND EXCLUSION CRITERIA

The inclusion of unpublished and grey literature is essential for minimizing the potential effect of publication bias (Cochrane Corner 2007). If systematic reviews are limited to published studies, they risk excluding vital evidence and yielding inaccurate results, which are likely to be biased as always positive results (Alderan 2002). The inclusion criteria should consider gender, age of participants, year(s) of publication and study type. For this review purpose, as conventional and conservative oxygen therapy studies are the primary research questions, patients aged 18 years or older and admitted to the Intensive Care Unit (ICU) with an expected length of stay of 72 hours or longer were considered for inclusion.

Exclusion criteria also need to be justified and detailed and papers may be excluded according to paper type (such as discussion papers or opinion pieces), language, participant characteristics, or year(s) of publication. For the exclusion criteria, patients under 18 years, pregnant patients, and those who were readmitted in ICU, patients with DNACPR (do not actively resuscitate) and neutropenia or immunosuppression and the patients on who more than one arterial blood gas analysis was performed in 24 hours.


STUDY SELECTION

For the purpose of this research proposal the literature selected are based on Randomized Clinical Trials of

conservative oxygen therapy methods and conventional (traditional)

[AD4]
oxygen therapy methods used in ICU and some systematic reviews of effective oxygen therapy in ICU, if they met the inclusion criteria. The controlled clinical trials provide the most appropriate method of testing effectiveness of treatments (Barton 2000). Observational studies on effect of hyperopia on post cardiac arrest are also reviewed.

These studies can help to determine whether conservative oxygen therapy can help increase mortality among critically ill patients.


PREPARATION FOR DATA EXTRACTION

Data will be

[AD5]
extracted from the studies and grouped according to outcome measure. The data extraction tools should be used to ensure relevant data’s is collected, minimise the risk of transcription errors, allow accuracy of data to be checked and serve as a record of the data collected.

The data collected for extraction should be validated against evidence. It is necessary to extract the necessary studies and data that will help in resolving the research question which involves analysing different studies and a preferred way of methodology that reduces errors and bias.


QUALITY ASSESSMENT

Cochrane risk of bias tool (Higgins2011) will be

[AD6]
used for the assessment of risk of bias in estimating the study outcome. For the better outcome of this review involved few randomized clinical trials, some observational studies and pilot RCT studies for comparison among various methods.

Quality assessment is given special importance because of the inclusion of RCT and non-RCT methodology (Eggers et al 2001). And only quality studies that satisfies the inclusion, exclusion and data requirements, validity and no bias and studies that are needed to answer the research question are carefully selected.


SYNTHESIS STUDIES

Synthesis helps to summarize and connect different sources to review the literature on a specific topic, give suggestions, and link the practice to the research (Cosette 2000). It is done by gathering and comparing evidence from a variety of sources when there is conflicting evidence or limited number of patients or large amounts of unclassified data. Systematic reviews of RCT’s(Randomized control Trial) encompass the most strong form of clinical evidence (Sheik 2002) and occupies the highest layer in the hierarchy of evidence-based research, at the same time qualitative case studies and expert opinions occupy the lowest layer (Evans 2003 and Frymark et al 2009).

RCT helps to understand the differences data among various studies (For Example, the studies considered here, conventional versus Conservative Oxygen therapy methods). RCT is the most applicable study used in assessing the results of an intervention, because it limits the effects of bias when performed correctly. (CRD’s Guide 2009). It also easier to understand and any observed effect is easily contained to the treatments being compared. (Stuart 2000). The favourable results of an RCT lies with the methodology domain followed in the trial and it reviews its practicality which helps healthcare professionals, clinicians, researchers, policymakers and guideline developers to apply and review the effectiveness of the trials and tests. For example, if a study overestimates the effects of an intervention, it concludes wrongfully that the intervention works; similarly if the study is underestimating the effects, it wrongfully reflects that there is no effect to that study. This is where RCT’s stands out, where minimum bias and evidence is the basis of such a study (According to Cochrane reviews). Hence this is why RCT’s form the gold standard of comparison studies while questioning effectiveness of different interventions while limiting bias. As an example, groups that are randomly assigned are different from groups that follow criteria in the sense that the investigator may not be aware of certain attributes that they might have missed. It will also be likely that the two groups will be the similar on significant characteristics using chance. It is possible to control the factors that are known but randomisation helps to control the factors that are not known, which drastically reduces bias. Therefore assigning participants in other study designs may not be as fair and each participant may vary in characteristics on main standards. (Cochrane Handbook for Systematic Reviews of Interventions 2017)

The observational studies or non-randomised studies can be argumentative as the choice of treatment for each person and the observed results may cause differences among patients being given the different types of treatments. (Stuart 2000).


ETHICAL CONSIDERATION

A systematic review is the scientific way of classifying the overabundant amount of information existing in research by systematically reviewing and accurately examining the studies concerning a particular topic. But in doing so, topic of ethics is hardly questioned. This will have some major downsides as some systematic reviews may have studies with ethical deficiencies, which in turn lead to the publication of an unethical research and such research is susceptible to bias. Systematic review does not automatically give the updated approval for an original study. Hence systematic reviews that are methodically and ethically assessed will have better ethical and methodological studies overall (Jean et al 2010). If an original study does not mention the ethical issues, it does not automatically mean that the studies in original papers avoided those ethical concerns and may indicate a lower risk (Tuech 2005).A primary rule for publishing articles is that redundant and overlapping data should be avoided or needs to be cross-referenced while making the purpose clear to the readers in an unavoidable case. (Elizabeth et al 2011). Plagiarism is clearly unacceptable and care should be taken care to not replicate other people’s research work and the original words and data needs to be acknowledged as a citation or quote. A responsible publisher should follow the COPE (Committee on Publication Ethics) flowchart that explains suspected plagiarism (Liz 2008). It is also important to give information on funding and competing interests. The Cochrane Collaboration (2011) has very strict rules about funding and it is important to give reasons why the author may or may not be neutral or impartial on the review prepared and it relates to financial support, while competing interests can be personal, academic or political (WAME Editorial Policy and Publication Ethics Committees 2009).


REFLECTION

The objective of systematic reviews is to translate the results to clinically useful and applicable information while meeting the highest methodological standards. They offer a very useful summary of the present scientific evidence on a particular domain which can be developed into guidelines on the basis of such evidence. However, it is imperative that practitioners understand the reviews and the quality of the methodology and evidence used (Franco 2012). This study proposes to find the systematic review approach of conservative and conventional oxygen therapy methods used among critically ill adult patients in ICU. Incidentally, a RCT study by Susan (2016) found that the strategy of conservatively controlling oxygen delivery to patients in ICU results in lower mortality than the conventional and more liberal approach whereby patients are often kept in a hyperoxemic state.