Hypertensive Patients In Evidence-Based Practice Homework Essay Sample

Research Support

In the PICOT question for this project, the constituent parts are as follows:

  • P – patients aged 50 years and older;
  • I – the adherence to antihypertension drugs;
  • C – inconsistency or nonadherence to antihypertension drugs;
  • O – decrease in hypertension;
  • T – when done over six months.

The specified population is important for this project because older adults are more subject to hypertension and its complications. The adherence to antihypertension drugs has been proved to increase patient outcomes; therefore, it has been chosen as an intervention. A significant part of hypertensive patients do not or poorly adhere to their medications (Abegaz et al., 2017). Therefore, it has been chosen as a comparison since it is important to identify the magnitude of the effect of adherence compared to nonadherence. Hypertensive patients suffer from high blood pressure, so the desired health outcome for them is a decrease in hypertension. Finally, the project should be long enough to identify the difference in health outcomes resulting from the chosen intervention; therefore, a period of six months has been chosen.

The need for research guided by the identified PICOT question is supported by the existing literature. For example, Peacock and Krousel-Wood (2017) admit that the link between high adherence to antihypertensive drugs and decreased blood pressure is strong Yet, they call for further research in this field to find out the relation between adherence to medications and a broad spectrum of patient health outcomes (Peacock & Krousel-Wood, 2017). Various studies show that hypertension is a common disease, especially among older adults, and high adherence is a feasible solution for patients suffering from this illness.

Search Method

To identify studies related to the formulated PICOT question, the search through two databases, Google Scholar and PubMed, was performed. The criterion for exclusion was the date of publication earlier than 2016; therefore, the search was limited to the articles published between 2016 and 2020. The keywords used included antihypertensive drugs, adherence, and older adults. The operator AND was used to find results related to all three keywords. In PubMed, the search filters were also applied, namely, meta-analysis, randomized control trial, and systematic reviews. PubMed found 14 articles matching the specified publication date, filters, and keywords, two of which appeared to be relevant to the topic. In Google Scholar, the search showed 19,400 results, which were sorted by relevance; therefore, only the first several pages were explored, and five more relevant articles were found.

Out of the total of seven articles that appeared in the initial reference list, three were excluded. The criterion for exclusion was an irrelevance to the PICOT question since these articles did not investigate the association between adherence to hypertension and patient health outcomes. Instead, they were focused on reasons why patients did not adhere to medications and possible interventions to improve adherence. The final selection of articles included three studies: one systematic review, one cohort study, and one case-control study.

Summary of Studies Used

The first study was a systematic review of studies exploring hypertensive patients’ nonadherence to their medications. It was conducted by Abegaz et al. (2017), and the findings indicated that 45.2% of hypertensive patients and 83.7% of patients with uncontrolled blood pressure did not adhere to their antihypertensive drugs. They also found evidence that nonadherence to medications leads to high risks of cardiovascular events and stroke. The strength of their study is that they used 28 high-quality articles from 15 countries, which included a total sample of 13,688 subjects (Abegaz et al., 2017). The study is of value to healthcare professionals since it identified characteristics of patients who were more likely to show poor adherence to medications. Yet, it has limitations, which is the high level of heterogeneity of studies. See Appendix for the review of literature evaluation table, which includes data about this and further articles.

The second study aimed at proving the hypothesis that high adherence to medications in adults aged 85 years and older led to a reduced risk of cardiovascular events. It was performed by Corrao et al. (2017), who used a cohort of older patients with hypertension who were not previously treated with antihypertensive drugs. Their results confirmed their hypothesis since older patients who adhered to their medications showed a decreased risk of cardiovascular events than their low-adherent counterparts. The strength of the study was the exploration of a large unselected sample, and the limitation was the use of information about drug prescriptions to determine levels of adherence.

Kim et al. (2018) aimed at exploring the long-term effects of adherence to medications in patients who survived an acute hemorrhagic stroke. Their retrospective cohort study showed that patients who adhered to antihypertensive drugs after the acute hemorrhagic stroke had a reduced risk of such adverse events as recurrent stroke or myocardial infarction compared to non-adherent patients. The strength of the study is that it explores the effects of adherence in a specific group of patients. Yet, the limitation is that the study was retrospective, which means that the causal relationship between adherence and adverse events after acute hemorrhagic stroke could not be established.

Selection of Research

All the studies selected for the research support were evaluated using Rapid Critical Appraisal Checklists fit for particular types of studies and appeared to have valid results, which corresponded to the expected outcomes. The chosen three articles are relevant to the PICOT question since they prove the benefit of high adherence to antihypertensive drugs for a decrease in hypertension and demonstrate that nonadherence leads to increased health risks. The selected studies have levels of evidence IV and V; therefore, the evidence provided in them is reliable.

References

Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., & Elnour, A. A. (2017). Nonadherence to antihypertensive drugs. Medicine, 96(4), 1-9.

Corrao, G., Rea, F., Monzio Compagnoni, M., Merlino, L., & Mancia, G. (2017). Protective effects of antihypertensive treatment in patients aged 85 years or older. Journal of Hypertension, 35(7), 1432-1441.

Kim, J., Bushnell, C. D., Lee, H. S., & Han, S. W. (2018). Effect of adherence to antihypertensive medication on the long-term outcome after hemorrhagic stroke in Korea. Hypertension, 72(2), 391-398.

Peacock, E., & Krousel-Wood, M. (2017). Adherence to antihypertensive therapy. Medical Clinics of North America, 101(1), 229-245.

Appendix

Review of Literature Evaluation Table

Citation: Author

Date of Publication & Title

Purpose of study Conceptual Framework Design Method Sample/ Setting Major Variable Studied and Their Definition Measurement of Major Variables Data Analysis Study Findings Worth to Practice:

LOE

Strengths/ Weaknesses

Feasibility

Conclusion

Recommendation

Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., & Elnour, A. A. (2017). Nonadherence to antihypertensive drugs. Medicine, 96(4), 1-9. Web. To explore nonadherence to medications in adults hypertensive patients Identifying research studies investigating hypertensive patients’ adherence to drugs

  • Systematic review using narrative synthesis
  • Inclusion and exclusion criteria specified

Out of 912 identified articles retrieved from PubMed, Google Scholar, and Scopus, 28 were included in the review, 25 of which were included in the meta-analysis. Nonadherence Included various study designs from the 28 studies Meta-analysis using StatsDirect statistical

software version 3.0.

  • Nonadherence to antihypertensive drugs leads to increased risks of cardiovascular events and strokes.
  • 42,5% of hypertensive patients were nonadherent to drugs.
  • 83,7% of patients with uncontrolled BP did not adhere to medications.

LOE: V. The study used relevant high-quality studies and obtained stronger evidence on nonadherence among hypertensive patients and its relation to gender, race, and the presence of comorbidities.

However, there were high levels of heterogeneity across studies.

The study showed that the level of nonadherence among hypertensive patients was high. The study is feasible since is identifies the scope of the problem with hypertensive patients. The study recommends to implement interventions increasing adherence and develop new methods of monitoring adherence.

Corrao, G., Rea, F., Monzio Compagnoni, M., Merlino, L., & Mancia, G. (2017). Protective effects of antihypertensive treatment in patients aged 85 years or older. Journal of Hypertension, 35(7), 1432-1441. Web. To evaluate the reduction of risks of cardiovascular events in 85-year-old and older individuals associated with adherence to medications Adherence to antihypertensive drugs reduces the risk of cardiovascular events in patients aged 85 and older A nested case-control study A cohort of 85-year-old and older patients, who were

newly treated with antihypertensive drugs in 2007- 2009. The setting was Lombardy (Italy).

Adherence to medications; the risk of cardiovascular events Adherence was measured by the number of days covered by medication prescription. The chi-square was applied to explore differences between groups. The Statistical Analysis System Software

was used for the

analyses

Adherence to antihypertensive drugs reduced the risk of cardiovascular events in elderly and very elderly patients compared to patients with very low adherence. LOE: IV.

The study used a large unselected population, and the drug prescription data was highly accurate. However, the sample size was not large enough to make generalized conclusions, and the level of adherence was derived from drug prescriptions. The study concluded that adherence to antihypertension drugs significantly reduced the risk of cardiovascular events in older adults. Recommendations are to increase adherence in older patients.

Kim, J., Bushnell, C. D., Lee, H. S., & Han, S. W. (2018). Effect of adherence to antihypertensive medication on the long-term outcome after hemorrhagic stroke in Korea. Hypertension, 72(2), 391-398. Web. To evaluate adherence to drugs in patients

with acute hemorrhagic stroke and its impact on long-term outcomes

Adherence to antihypertensive drugs after acute hemorrhagic stroke improves long-term patient outcomes Retrospective cohort study 1872 hypertensive patients

admitted with acute hemorrhagic stroke between2002 and 2013 in South Korea

Adherence, patient outcomes Adherence was measured as the number of days covered by the prescribed medication. Outcomes were defined as the recurrent stroke, myocardial infarction, or all-cause mortality. Time-dependent Cox

proportional hazard regression analyses

The proportion of patients with good

adherence was only 46.8% at 1 year, 43.2% at 3 years, and

41.7% at 5 years of follow-up. Poor adherence to drugs after stroke led to adverse events.

LOE: IV.

The strength of the study is that it evaluates the long-term outcomes of adherence after acute hemorrhagic stroke. However, since the study was retrospective, the causal relationship between poor adherence and an increased risk of cardiovascular events could not be proved. The conclusion was that adherence to medications after stroke improved patient outcomes. The recommendation was for healthcare professionals to improve patients’ adherence to drugs after acute hemorrhagic stroke.

Healthcare: Lumbar And Sacral Region

The Sacrum

The sacral spine is a large bone that consists of five vertebrae fused below the lumbar region. It is also referred to as the sacrum. A spinal canal stretches towards the sacrum. Sacral nerves exit the canal through a thick region known as the foramina. A lumbosacral disk separates the sacrum from the base of the last sacrum. The sacrum acts as a wedge between the iliac and the pelvic bones. It is supported by two sacroiliac joints. Most back-related problems occur in the region where the lumbar and sacral regions are in contact. This particular region is usually subjected to a great deal of pressure. Sacral Ala is a region that connects the sacrum to the pelvis. Surgeons use this region as a sort of clamp for their instruments. This aids in supporting the lumbosacral intersection. Sacral Ala is also known as the wings of the sacrum because of its peculiar shape.

The Lumbar Spine

There are twenty-four vertebrae in the spine. Codes are therefore used to number each of these vertebrae. The lumbar region begins in the lower back of the spine, below the thoracic and cervical regions. These two regions are located above the sacrum. The lumbar is often associated with back pains and other forms of spinal discomfort. This is because of the lumbar experiences large amounts of pressure from the rest of the body. It is often marked from L1 to L5. It is the strongest part of the spine. The L1level represents the end of the spinal cord. The spine is divided into nerve roots that run down to the lower extremities of the human body. These roots are known as the cauda equina.

Spinal diseases occur due to many different pathological processes (Gondim and Thomas). One of these processes is trauma. It is the most frequently observed cause of injury. According to Gondim et al (2009), spinal cord disease can manifest through the sensory, motor, or autonomic function impairment.

Normal Patient Anatomy

Medically speaking, normal patient anatomy refers to the general physical characteristics of every individual. Anatomy, however, varies from patient to patient. Different races have different anatomical characteristics. In general, men are more heavyset than women. The bone structure of a male patient is adapted for heavy labor. In the same way, a female’s bone structure is adapted for various maternal specifications. Likewise, children’s bones tend to be more fragile than those of teenagers. Many environmental factors also affect normal patient anatomy. People from different geographical locations have different bone structures.

Routine projections tend to vary based on the above hypotheses. Radiologists make their diagnoses on the basis of these statements. Some tend to generalize their discoveries based on these assumptions. Patients can therefore be misdiagnosed because of their age, their sex, or their race.

It is therefore important for radiologists to avoid making assumptions concerning human anatomy. Descriptive reports on patients ensure that the right diagnosis is made.

Radiographic Charts and Projections

Radiographic charts are vital in the diagnosis of numerous spinal diseases. Radiography involving the thorax can provide information about abnormalities in regions like the mediastinal spaces. Surgeons can stand to benefit greatly from these images. Patients, in turn, can receive the proper treatment that they deserve. This is possible only if a descriptive approach is taken. Radiologists are tasked with providing the secondary parties with a full review and diagnosis of the charts and projections.

Osteoid osteoma is one of the problems that affect the lumbar and the sacrum. Normal patient anatomy makes it difficult to diagnose this condition because both the lumbar and the sacrum are infrequently localized (Villas, Lopez and Zubieta, 1990). Radiography charts that involve these regions are often difficult to read. It is therefore important to be very specific when describing the radiographic results. Villas et al (1990) discovered “the scintigraphy to be of invaluable assistance in revealing the presence of this small nodular lesion of the spine, and the computed axial tomography (CAT) scan study was likewise useful for its precision in localizing the tumor as a basis for deciding upon a viable surgical approach”. Projections of the disease can only be deciphered by professionals. The same professionals should therefore give a descriptive report to their surgical counterparts, who may disregard generalized analyses.

Radiographic projections of the thorax can be valuable in diagnosing such diseases. Physiologists should therefore use valid descriptions during their diagnosis. Projections from radiographic tests can be used to determine the extent of damage on the spine. It is important to use intricate descriptions in order to prevent further lesions.

According to Villas et al (1990), the symptoms of Osteoid osteoma can be relieved through the process of surgical resection. This involves fusing the regions using an artificial clamp. Only a valid description can decide whether or not to use the specified treatment. Generalized results can lead to a misdiagnosis.

Magnification and Visibility

Most radiographic projections are generally inconclusive. This is due to the fact that mass visibility tends to be difficult to read. Human beings are hardly ever viewed as anatomically similar. Physiologists may be able to detect spinal flaws in one patient while inadvertently ignoring flaws in another. Intricate diagnoses are therefore justified by the fact that normal anatomy varies from patient to patient.

Lumbar Zygapophyseal Joint Pain (LZJ) is one of the many spinal cord diseases that are difficult to diagnose (The Free Library, 2009). Physiologists can be misled by radiographic charts that fail to detect LZJ disease. Magnification of charts can alter the clarity of images. Description of the process can enable consequent parties to draw the right conclusions concerning a patient’s condition.

The lumbar spine can be fractured when the force applied to the lower spine has exceeded the strength and uniformity of the spinal column unit (Nadalo and Moody, 2010). Lumbar fractures can result from blunt force trauma and penetration from sharp objects like knives or machetes. Magnification ensures that even the smallest fractures are detected. Many doctors may be unable to detect such minor damage. Radiologists, however, are trained to take note of even the smallest of lesions. It falls to them to give surgeons and other related parties an intricate analysis of all their images.

Object Focal Distance

Object Focal Distance is often viewed in x-rays. It is sometimes vague and therefore difficult to interpret. However, OFD can be adjusted. Radiologists have noted that small focal points are better than large ones. Small focal points can be used to compensate for an increase in OFD.

Movement

During x- rays, a patient is advised to stay perfectly still. Movement can alter the results of radiographic tests. Images often appear to be blurred when patients fail to hold their breath during an examination. This can alter the radiologist’s diagnosis. A general approach to interpreting such data is ill-advised. It is better to be concise and descriptive.

Relative Speed Value

Relative Speed Value represents the rate at which the screen and film projections are processed. Low RSV has high radiation but produces an accurate image of a patient’s anatomy. High RSV has low radiation and poor image quality. Such data must be taken into account by all radiologists. Descriptive analysis ensures that patients receive proper treatment and diagnosis despite the flaws that such techniques present.

The Delphi Technique

Some radiologists have been known to misdiagnose LZJ pain as normal back pain. As a result, scientists have come up with the Delphi Technique. It derives its name from the Oracle of Delphi. The Oracle is a mythical deity who was Apollo’s emissary. She was cursed because, despite her accurate prophecies, she would always be doubted. Likewise, the Delphi technique uses assumptions from various credible parties to draw near-accurate conclusions from radiographic charts. “The Delphi technique is a method for systematically collecting informed judgments from a group of experts on specific questions or issues” (The Free Library, 2009).

According to an article from The Free Library (2009), the Delphi technique has been used to obtain a consensus on the indicators of LZJ pain. Doctors are able to make reliable hypotheses based on their experiences. The technique is not, however, accurate. It leaves little room for error. The same article states that despite the lack of guidelines, the Delphi approach favors a reliable panel of 20 experts (The Free Library, 2009).

Physiologists who apply this technique take a more descriptive approach. The charts are viewed by multiple parties ensuring the well-being of the patient. Other techniques involving one radiologist may lead to a misdiagnosis. Most projections are vague and therefore difficult to interpret. An in-depth analysis ensures that there is very little room for error.

Radiology Techniques and Diagnosis

Magnetic Resonance

The advent of new Magnetic Resonance (MR) devices has enabled doctors to detect spinal defects on a more accurate level. These new developments have ensured that clinical imaging of the spinal regions is reviewed by experts (Backes and Nijenhuis, 2008). The most current MR techniques can visualize the vessels that supply spinal fluid to the human vertebrae (Backes et al, 2008). These new approaches in the field of radiography can ensure that patients are properly cared for. Backes et al (2008), states that the success of this process relies on expert knowledge concerning the spinal region.

MR diagnosis was initially based on changes in the appearance of the chord tissue “but not on direct visualization of abnormal vessels” (Krings, Mull, and Gilsbach, 2005). This initial diagnosis left some room for error. It was also not completely accurate.

Before the year 2000 conventional MR angiographic methods could only detect dilated veins and arteries (Pattany, Sarsaf-Lavi and Bowen, 2003). It is now possible to detect most, if not all of the spinal regions.

Catheter Angiography

Some scientists have outlined catheter angiography as one of the best imaging techniques in the detection of spinal vascular lesions (Krings, Lasjaunias and Hans, 2007).

Aside from conventional radiography, CT is quite possibly the best way to represent external images. (Dai, Wang and Jiang, 2008). They are used by a majority of surgeons. According to Dai et al (2008), CT scans are equipped to detect the subtle regions of the spinal canal. It is therefore important for radiologists to be specific when they are describing radiographic images. Assumptions can lead to a misdiagnosis. This puts the patients’ lives in danger. Generalizations of radiographic scans can lead to permanent spinal damage. Physiologists should therefore practice with professional integrity in order to avoid such mistakes.

The radiation from the process can lead to various complications (Savader and Williams, 1993, Kiefer and Chiras, 2002). Savader et al (1993) and Kiefer et al (2002) point out the fact that the machines used in the process have superior image quality.

Kieffer et al (2002) argue that the process is time-consuming and can only be carried out by professional radiologists. Williams, Rosenborough, and Webb (2004) argue that new developments in angiography are therefore necessary. These advancements can ensure the well-being of patients with diseases like LZJ.

Catheter angiography is, however, regarded as unfavorable because it has the potential to dislocate the aortic thrombi (Kieffer et al, 2002). This method is unable to detect certain vessels in the spinal cord (Fereshetian, Kadir, and Kaufman, 1989).

Japanese research has recently demonstrated advances in angiography (Yamada and Kuribayashi, 2000). Scientists have reported an increase in the success rate of diagnoses.

Intravenous photosensitive agents have also greatly increased the chances of detecting veins and arteries (Takase, Sawamur and Igarashi, 2008). This has been a milestone in the field of radiology.

Thron (2002) argues that adequate knowledge is needed to interpret radiologic diagrams. Lasjaunias, Berenstein and TerBrugge (2001) agree. There are still many parts of the human anatomy that remain uncharted. As such, radiographs should undergo intense scrutiny before conclusions are drawn.

Backs et al (2010) argue that axial CT scans are sometimes unable to detect horizontal injuries that may occur in the spine.

Ultrasound Transducers

Ultrasound transducers can also be used to detect anomalies in the human anatomy. They use high frequencies to generate two-dimensional images. They are mostly used on expectant mothers to view images of the fetus. The projections are usually faint and grey. Nevertheless, it is important to give full reports regarding the state of affairs.

Physiologists often prescribe painkillers if they are unable to detect flaws in a patient’s radiographic images. Orthopedic mattresses have also been prescribed in mild cases. Chiropractors are sometimes able to reduce the tension caused by periodic back pain.

Nevertheless, doctors should always ensure that radiographs are analyzed by professionals. Precautions should always be taken.

Only experts can discern such charts and diagrams. Radiologists are therefore expected to detect spinal fractures with the greatest amount of accuracy (Nadalo et al, 2010).

Recent studies have shown that whole spine MRIs can be used to determine the variations in the anatomy of the lumbar spine (Hanson, Mishra, Chang, Perkins, Bonifield and Tandy, 2010). According to Hanson et al (2010), variations from normal lumbar spine anatomy often lead to a misdiagnosis. Even well-renowned doctors can make mistakes. Chest CT scans and abdominopelvic CT scans have been used to detect spine fractures in blunt trauma patients (Gross, 2010). According to Gross (2010), the differences in sensitivity were significant for both comparisons. Descriptive reports can ensure that such subtle differences are accounted for.

A review of earthquake survivors in China was done on several patients who sustained serious injuries. Multi-level spine-related injuries confirmed the need for intricate assessment of such victims (Chen, Song, Kong, Zhou, and Liu, 2009).

A study carried out by Chinese scientists reported that 87 patients with thoracolumbar burst fractures were diagnosed based on the extent of initial spinal canal encroachment and “kyphotic deformity” (Dai, Wang, and Jiang, 2007). Intricate research such as this paves the way for future radiologists.

Studies have shown that surgeons are unable to conclusively diagnose rare or irregular forms of spinal disease. This is due to the fact that normal human anatomy varies according to race, sex, and age. Backes et al (2008) conclude that Africans have a generally greater bone density than most other races. Environmental factors may alter these findings. The same article also notes that people who play competitive sports are more likely to hurt themselves than those who don’t. Young males and professional athletes are therefore difficult to diagnose (Backes et al, 2008). Childhood injuries and bone fractures are not easily detected in radiographs. Though generalized radiographic reports save on time, they can lead to further or permanent damage. Descriptive reports have been known to prevent paralysis.

Backes et al (2008) also note that compression fractures are more common in older women than in their male counterparts. Descriptive diagnosis ensures that patients with fragile bones are properly taken care of.

For the sake of simplicity in treatment and diagnosis, fractures are grouped by the first four letters of the alphabet. Scientists have come up with a system known as the Denis Classification. Type A fractures include both endplates of the spine. Type B involves the superior endplate. Type C involves the inferior endplate while D involves the collapse of the anterior cortex.

The lumbar spinal canal is wider than some of the spinal regions. It is, therefore, less susceptible to damage. Greater damage can be detected by radiologists. Nerve root damage can only be detected during surgery. This is possible only if the damage is substantial. An article by Patel, Dailey, Brodke, Daubs, Harrop, and Whang (2009) states the following:

“The Thoracolumbar Injury Classification and Severity Score (TLICS) is a more recent attempt to place thoracolumbar spine trauma into a more comprehensive clinical context. The TLICS system identifies 3 major injury characteristics including injury morphology, posterior ligamentous complex integrity, and neurological status. Minor injury characteristics and individual variables (such as ankylosing spondylitis), multisystem trauma, and chest wall injuries are considered. The TLICS system has been demonstrated to be valid. The TLICS can be incorporated into clinical practice”.

Tamir, Anekstein, Mirovsky, Heim, and Dudkiewiczs (2006) argue that “standard anteroposterior (AP) and lateral radiographs should be obtained in all patients”. Tamir et al (2006) discovered that lumbar and thoracic spine radiographs were inconclusive when detecting a dislocation or a fracture.

Conclusion

Backes et al (2008) acknowledge the fact that new radiographic technology has contributed greatly to the scientific community. It has been proven that MR angiography is more effective than catheter angiography. It is still important to note that all final decisions concerning diagnosis and treatment fall on the radiologists.

Some medical scans are inconclusive. Fractures are not always easy to detect because normal anatomy varies according to several internal and external factors. Surgeons and radiologists should therefore work for hand in hand to avoid mistakes. If precautions are taken, many spine-related injuries will most likely improve can be corrected. Some patients may even be at liberty to forego major surgery if abnormalities are detected on time.

Reference List

Backes W.H. and Nijenhuis R.J. (2008). Advances in Spinal Cord MR Angiography. American Journal of Neuroradiology. 29:619-631. Web.

Chen R., Song Y., Kong Q., Zhou C. and Liu L. (2009). Analysis of 78 patients with spinal injuries in the 2008 Sichuan, China, earthquake. Orthopedics; 32(5):322. Web.

Dai L.Y., Wang X.Y. and Jiang L.S. (2007). Neurologic recovery from thoracolumbar burst fractures: is it predicted by the amount of initial canal encroachment and kyphotic deformity? Surg Neurol. Web.

Fereshetian A., Kadir S. and Kaufman S.L. (1989). Digital subtraction spinal cord angiography in patients undergoing thoracic aneurysm surgery. Cardiovasc Intervent Radiol 1989; 12:7–9. Web.

Gondim F.A.A. and Thomas P.F. (2009). Spinal Cord, Topographical and Functional Anatomy. Web.

Gross E.A. (2010). Computed tomographic screening for thoracic and lumbar fractures: is spine reformatting necessary? Am J Emerg Med. Web.

Hanson E.H., Mishra R.K., Chang D.S., Perkins T.G., Bonifield D.R., Tandy R.D., et al. (2010).Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies. J. Neurosurg Spine. Web.

Kieffer E., Fukui S. and Chiras J. (2002).Spinal cord arteriography: a safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy. J Vasc Surg; 35:262–68. Web.

Krings T., Lasjaunias P.L.. and Hans F.J. (2007).Imaging in spinal vascular disease. Neuroimaging Clin N Am;17:57–72. Web.

Krings T., Mull M. and Gilsbach J.M. (2005). Spinal vascular malformations. Eur Radiol; 15:267–78. Web.

Lasjaunias P., Berenstein A. and TerBrugge K.G. (2001). Spinal and Spinal Cord Arteries and Veins. Berlin: Springer-Verlag; Web.

Nadalo L.A. and Moody J.A. (2010). Lumbar Spine Trauma. Web.

Patel A.A., Dailey A., Brodke D.S., Daubs M., Harrop J., Whang P.G., et al. (2009). Thoracolumbarspine trauma classification: the Thoracolumbar InjuryClassification and Severity Score system and case examples. J Neurosurg Spine.Web.

Pattany P.M., Saraf-Lavi E., Bowen B.C. (2003). MR angiography of the spine and spinal cord. Top Magn Reson Imaging 2003; 14:444–60. Web.

Savader S.J., Williams G.M. and Trerotola S.O. (1993). Preoperative spinal artery localization and its relationship to postoperative neurologic complications. Radiology; 189:165–71. Web.

Takase K., Sawamura Y. and Igarashi K. (2008). Demonstration of the artery of Adamkiewicz at multi-detector row helical CT. Radiology; 223:39–45. Web.

Tamir E., Anekstein Y., Mirovsky Y., Heim M. and Dudkiewicz I. (2006). Thoracic and Lumbar spine radiographs for walking trauma patients–is it necessary? J Emerg Med. Web.

The Free Library. (2009). Indicators of lumbar zygapophyseal joint pain. Survey of an Expert. Web.

Thron A. (2002).Vascular Anatomy of the Spine. Oxford: Oxford University Press; Web.

Villas C., López R., and Zubieta J.L. (1990). Osteoid osteoma in the lumbar and sacral regions: two cases of difficult diagnosis. Department of Orthopaedic Surgery, University Clinic of Navarra, Pamplona, Spain. J Spinal Disord. Web.

Williams G.M., Roseborough G.S and Webb T.H. (2004). Preoperative selective intercostal angiography in patients undergoing thoracoabdominal aneurysm repair. J Vasc Surg; 39:314–21. Web.

Yamada N, Takamiya M and Kuribayashi S. MRA of the Adamkiewicz artery: a preoperative study for thoracic aortic aneurysm. J Comput Assist Tomogr– 2000; 24:362–68. Web.

Madeleine Leininger’s Culture Care Theory

The theory of culture care developed by Madeiene Leininger can have profound implications for the work of many nurses and other healthcare professionals. It is critical to examine the way in which the so-called called meta-paradigm concepts are described within this framework. In particular, one should pay close attention to such notions as person, nursing, environment, and health since they guise the strategies of healthcare organizations. Moreover, it is necessary to show how these concepts are related. On the whole, one can say that this theory sets new standards of performance for medical workers who need to consider the way in which a person perceives such notions as health or wellbeing. These are the main questions that should be discussed more closely.

This theory is based on the premise that the work of nurses should be consistent with the cultural values, beliefs, and practices of a person (Sitzman & Eichelberger, 2010, p. 94). This emphasis on culture is important for improving the quality of care. In turn, this framework provides specific definitions of the notions that are critical for the work of nursing. At first, one should mention that such a concept as person can be applied to a human being, social group, family, community, and even institution (Masters, 2014, p. 68). Therefore, medical workers should consider those external factors that influence the behavior of person. Much attention should be paid to the notion of health which can be described as the state of well-being as it is described in a particular culture (Sitzman & Eichelberger, 2010, p. 95). Therefore, nurses and medical workers should consider the worldviews of the patient while providing healthcare to this individual. This theory also implies that healthcare professionals cannot use a single definition of health since it is determined by a specific cultural background of a patient (Leininger, 1990). This is one of the main details that should be taken into account.

Furthermore, the supporters of this theory lay stress on the concept of the environment which is defined as the set of physical, sociopolitical, ecological, and cultural factors influencing the worldviews of a person and his/her behavior (Andrews & Boyle, 2008; Leininger, 1990). These factors can signficantly affect the way in which a person experiences illness. Moreover, they influence their decisions about health and lifestyles. Finally, nursing can be viewed as those activities which are aimed at supporting the needs of patients in a way that is consisting with his/her cultural values or beliefs (Masters, 2014, p. 68). These are the main elements that can be distinguished. Overall, they shape the practices of many nurses, especially if they work with people representing different cultures. Under such circumstances, Madeleine Leininger’s theory can be particularly useful.

This theory implies that meta-paradigm concepts are related with one another in a specific way. First, this theory is based on the culturally-determined notion of health because it can be used for identifying the goals of medical workers. In turn, nursing activities should be adjusted to the cultural beliefs of a patient (Parker, 1993). This requirement means that healthcare workers should focus on the need the environment of a person since it influences his/her perceptions of health and illness. These connections between meta-paradigm concepts shape the daily work of nurses. These are the main aspects that can be distinguished.

Reference List

Andrews, M., & Boyle, J. (2008). Transcultural Concepts in Nursing Care. New York, NY: Lippincott Williams & Wilkins.

Leininger, M. (1990). Ethical and Moral Dimensions of Care. Detroit, MI: Wayne State University Press

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