RECOMMENDATION FOR AN EVIDENCE-BASED PRACTICE CHANGE POWERPOINT KALTURA PRESENTATION N A M E C H A M B E R L A I N U N I V E R S I T Y A D V A N C E D R E S E A R C H M E T H O D S : E V I D E... N C E B A S E D P R A C T I C E N R 5 0 5 A U G U S T , 2 0 2 0 OBJECTIVE The purpose of this kultura PowerPoint presentation is to advocated for practice change and provide Evidenced Based recommendations in relation to computed tomography radiation exposure to children and young adults. The presentation will include the following: 1. Introduction 2. Practice issue 3. Importance to nurse practitioner practice 4. PICOT question 5. Literature Review 6. Recommendations INTRODUCTION Computed tomography(CT) is frequently used worldwide and allows for the early detection and diagnoses of diseases, provides easy visualization of injuries, and it is used as a supportive guidance during surgical procedures. However, studies suggest that CT radiation exposure during childhood may be a risk factor for developing cancer. Safety measures should be implemented to decrease such risks. PRACTICE ISSUE My chosen area of interest is the relationship between computed tomography radiation exposure and cancer development in children and young adults. Issue: The use of computed tomography (CT) has increased dramatically over the past several decades. CT scan parameters are not appropriately adjusted for pediatric patients. PRACTICE ISSUE- IMPORTANCE TO NP PRACTICE Family nurse practitioners can: -Advocate for CT justification of use -Provide Education and increase patient and family awareness of the effect of CT scans -Advocate for patient’s safety measures and impact patient outcomes PICOT QUESTION In children and young adults, is the use of reduced dose of radiation exposure of computed tomography (CT) decrease the changes of cancer in comparison to higher dose during their lifetime? P-population The main focus of this PICOT question is the increase risk of developing cancer from exposure to ionizing computed tomography in children and young adults. The lack of justification and the lack of safety measures for CT usage can put this particular population at an increased risk. I- Intervention Balance between CT usage and safety measures is necessary. According to the U.S Food and Drug administration, guidelines and safety promotion should be implemented each time a CT examination is performed. Safety measures include justification for use, dose optimization, education and communication, appropriate use and equipment safety features. (U.S Food and Drug Administration, 2020). C-Comparison Safety measures avoid or decrease children exposure to CT radiation. O- Outcome Measurable outcomes can only be determined with data collection and data comparison through clinical studies. A desirable outcome is to reduction of reported cancer due to CT radiation exposures. T- Timeframe- Over a lifetime spam. LITERATURE REVIEW Many studies have examined the link between medical radiation and the risk of cancer. Many have agreed that intervention for change is critical. The radiation dose delivered from computed tomography (CT) scanning and the risks associated with ionizing radiation are major concerns in pediatric imaging. CT scans account for 42% of the total effective dose arising from medical diagnostic radiology. LITERATURE REVIEW -Children are especially vulnerable to the harmful effects of radiation because: -Their cells divide more rapidly -There is more time for the malignancy to manifest. -Evidence suggests that in many instances, CT doses can be reduced by 50% or more without reducing diagnostic accuracy. RECOMMENDATIONS According to the U.S Food and Drug administration, best practice guidelines and safety promotion should be implemented and follow each time a CT examination is performed. Best practice and safety measures include: justification for use, optimization, Education and communication. the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine. Communication RECOMMENDATIONS Prior consultation before CT examination is important for reducing the inappropriate or excessive use of imaging procedures. Pediatricians and radiologists should discuss whether CT is the best study to perform The promotion of the optimization of CT procedures and the use of non-irradiating techniques such as magnetic resonance imaging should be used, especially in children and young adults. RECOMMENDATIONS Education communication materials and education materials would be useful for parents that aim to reduce the number of unnecessary CT examinations. RECOMMENDATIONS Evidence based recommendations: Determining Fit, Feasibility, and appropriateness of Recommendations. Questions to be asked: - Would this change improve clinical outcomes? - Would this change improve patient or nurse satisfaction? - Would this change reduce the cost of care for patients? - Would this change Improve unit operations? The answer is yes, A previous study revealed that one-third of all CT scans were not justified by medical need, this emphases the need for EBP change for promotion of radiation safety for children. CONCLUSION While CT has greatly improved diagnostic capabilities, its use comes with risks, especially to children and young adults. The careful examination of exposure of CT scans and consideration of the uncertainties in dose estimation is a necessity. The promotion of the justification for use, optimization of CT, education, and communication should be implemented every time with every study. REFERENCE Al.Rammah T.Y.(2016).CT Radiation Dose Awareness Among Pediatricians. Italian Journal of Pediatrics. 42,77. Retrieved from https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0290-3#citeas Armao D., Hartman T., Shea M.C., Sams C., Ivanovic M., Fordham L., Smith J.K. (2016). Developing a Toolkit for Pediatric CT Dose Reduction in Community Hospitals. US National Library of Medicine National Institute of Health. 13(11):1337- 1342.ell. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097688/ Bindman R. S., Wang Y., Chu P., Chung R., Einstein A.J., Balcombe J., Cocker M., Das M., Delman B. N., Flynn M., Gould R., Lee R.K., Nelson T.Y., Schindera S., Sibert A., Starkey J., Suntharalungam S., Wetter A., Wildberger J.E., Miglioretti D. (2019). International Variation in Radiation Dose for Computed Tomography Examinations: TheBMJ. Retrieved from https://www.bmj.com/content/364/bmj.k4931 Dang, D., & Dearholt, S. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model & Guidelines. Sigma Theta Tau International. 8. Translation, Ideguchi R., Yoshida K., Ohtsuru A., Takamura N., Tsuchida T., Kimura H., Uetani M., Kudo T. (2018). The Present State of Radiation Exposure from Pediatric CT Examination In Japan-What Do We Have to Do? Journal of Radiation Reseach. Vol. 59,2p.130-136. Retrieved from https://academic.oup.com/jrr/article/59/suppl_2/ii130/4829569 Sadigh G., Kadom P., Karthik D., Sengupta., Strauss K.J.,Frush K.E.(2018). Noncontrast Head CT in Children: National Variation in Radiation Dose Indices in the United States. American Journal of Neuroradilogy. Vol 39, Issue 8. Retrieved from http://www.ajnr.org/content/39/8/1400 Rutger A. J., Nievelstein I.M., Dam V., Aart J., Molen V.D. (2020). Multidetector CT in children: Current concepts and dose reduction Strategies. Department of Pediatrics Radiation. Retrieved from https://www.researchgate.net/publication/44661036_Multidetector_CT_in_children_Current_concepts_and_dose_reductio n_strategies [Show More]
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