DNP 805 Select a defined patient population; for example, diabetic patients over 65 years of age

DNP 805 Select a defined patient population; for example, diabetic patients over 65 years of age

DNP 805 Select a defined patient population for example, diabetic patients over 65 years of age

Databases is a term used to describe a collection of information that is relatable and connected to the objects being assessed. They have become a very important part of our daily lives in this twenty first century and it can be logical or physical. There are different databases for different fields and the type of information collected is unique to each area. This information could be collected in different forms of entries like spreadsheets, files, indexes and tables (Alexander, Hoy, & Frith, 2019). The implementation of databases is done by understanding how it works with the structure, design, management, application and storage of data.

In healthcare, Databases are used to store large quantity of Data, such as for record keeping of patient information like demographics, diagnosis, treatment plans, patient care plans, medications, and progressions of care and to respond to answers to complex questions. These databases are easy to recover Data from them and are easily optimized and updated for faster access and has made it easy for HCP to exchange information (Alexander, Hoy, & Frith, 2019).

The patient population selected for this database is heart failure. Heart failure is the syndrome that characterizes increased heart pressures or decreased cardiac output when there is a dysfunction of the systolic and diastolic functions of the heart which produces symptoms of constant shortness of breath, Bilat lower extremity edema, fatigue, and the possibility of need for constant use of oxygen (Kınıcı, & Gürdoğan, 2022).

Some of the elements needed for chronic heart failure will be demographics which will include the age-number, gender-text, vital signs-numeric, intake and output-numeric, weight gain or loss-numeric, medications-text, frequency of shortness of breath-text and numeric, time of day-time, when short of breath occurs most-text and numeric (Newman, 2019). 

The frequency of sob could be text because you are noting that there is frequency of sob and then also noting how many times it occurs. Likewise, when the shortness of breath occurs most can be text as well as at what time it occurs most often.

References:

Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.

Kınıcı, E., & Gürdoğan, E. P. (2022). Hopelessness, Health Behaviors, and Quality of Life in Patients with Chronic Heart Failure. Journal of Education & Research in Nursing / Hemsirelikte Egitim ve Arastirma Dergisi19(1), 49–55. https://doi-org.lopes.idm.oclc.org/10.5152/jern.2022.79745

Newman, D. (2019). Healthcare database concepts – Databases in healthcare. Healthcare IT Skills, Health Information Technology Career Advice, Healthcare IT Certifications, Project Management, Job Tips. https://healthcareitskills.com/databases-in-healthcare-database-concepts/

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Thank you for your post, I agree with you that databases are used to store large quantity of data, such as for record keeping of patient information. Databases in healthcare sectors provide a proper system for storing, organizing, and managing critical health statistics such as labs, finances, billing and payments, patient identification, and more. This information must remain confidential to the public, but easily accessible for the healthcare professionals who use this data to save lives. The importance of database technology in healthcare cannot be overstated, it’s crucial for doctors, providers, and management teams to access in-depth health data quickly and without error. Healthcare operations, from large-scale to individual processes, depending on the accuracy and efficiency of healthcare databases. A healthcare database management system is an essential tool for databases in healthcare industries (Newman, D. 2019).

DNP 805 Select a defined patient population for example, diabetic patients over 65 years of age
DNP 805 Select a defined patient population for example, diabetic patients over 65 years of age

Databases used in the healthcare industry can store loads of information and can assist with several tasks, including the most important healthcare mission of saving lives. Along with supporting the daily operations of healthcare professionals, databases must also be efficient so that healthcare professionals can quickly and easily access relevant information when necessary.

Reference

Newman, D. (2019). Healthcare database concepts – Databases in healthcare. Healthcare IT Skills, Health Information Technology Career Advice, Healthcare IT Certifications, Project Management, Job Tips. https://healthcareitskills.com/databases-in-healthcare-database-concepts/

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Chronic heart failure (CHF)serves as a hospitalization’s primary cause for individuals beyond age 65, thereby representing burdens – such as economic and clinical. In addition, about half of hospital re-admissions are related to co-morbidities, polypharmacy, and disabilities associated with CHF (Tahhan et al., 2018).  

Age: Coinciding with age advancement resides the risk of heart, the primary reason for hospitalization among individuals 65 years and beyond (Tahhan et al., 2018).

Gender: Males present a higher inclination towards heart failure than their female counterparts. In contrast, females present themselves with a higher disposition towards developing diastolic heart failure (heart muscle fails to enter a relaxed state) (Tahhan et al., 2018).

Demographics: Heart disease trends indicate an increased likelihood of possessing a causal relationship with differences from either race or geography, dealing with treatment concerning heart disease prevention. Case in point, researchers had uncovered that within the Deep aspects of the South, traits such as the absence of physical activity, heightened blood pressure, as well as obesity was deemed conventional (Tahhan et al., 2018).    

Ethnicity: African-Americans are presented at a higher likelihood than their white counterparts of heart failure development prior to age 50 and pass away (Tahhan et al., 2018).

Genetics and Familial history: Individuals who are possessors of cardiomyopathies familial history (diseases inducing heart muscle injuries) see a higher heart failure likelihood. Researchers undergo investigation of genetic variants hailing from varying natures, which are accountable for the heightened potentiality of heart failure (Tahhan et al., 2018).

Comorbid Conditions: Diabetes, IHD, accompanied by hypertension, has undergone consistent reporting as a condition of comorbid nature, occurring within the initial heart failure hospitalization (Tahhan et al., 2018). Furthermore, individuals with diabetes see a high inclination toward heart failure, especially if individuals are also possessors of either increased blood pressure or even coronary artery disease (Tahhan et al., 2018). In addition, some instances of diabetes medications like rosiglitazone (Avandia) alongside pioglitazone (Actos) coincide with the potentiality of either worsening or inducing heart failure (Tahhan et al., 2018).  

Furthermore, the increase of risk pertaining to heart failure is indicative of how diabetes is accountable for inducing kidney disease. Hypertension served as the most conventional comorbid condition (Tahhan et al., 2018).

Socioeconomic Status: We assessed Medicaid eligibility as a potential surrogate for socioeconomic status that might affect survival. African American patients were three times more likely to be eligible for Medicaid than were Caucasian patients. In addition, women were possessors inclining twice as high to qualify for Medicaid compared to their male counterparts (Tahhan et al., 2018).

Lifestyle Factors: Immobile livelihoods, engagement in smoking, consumption of alcohol, and drug abuse can heighten heart failure. Obesity is associated with high blood pressure and type 2 diabetes, placing people at risk for heart failure. Evidence strongly suggests that obesity is a significant risk factor for heart failure, particularly in women (Tahhan et al., 2018).

Reference

Tahhan, A. S., Vaduganathan, M., Greene, S. J., Fonarow, G. C., Fiuzat, M., Jessup, M., … & Butler, J. (2018).    

Enrollment of older patients, women, and racial and ethnic minorities in contemporary heart failure clinical trials: a systematic review. JAMA cardiology, 3(10), 1011-1019.failure clinical trials: a systematic review. JAMA cardiology, 3(10), 1011-1019.

Suicide is one of the leading causes of death among depressed adolescents. Adolescents are vulnerable to suicide due to underlying mental health conditions and other social and emotional factors including trouble coping with stress, rejection, failure, school difficulties, and family issues (Cao et al., 2021). Depression screening for the adolescent population is imperative to preventing teen suicide attempts (Keeley, 2021). According to Cao et al. (2021), a depression screening tool catered to adolescence should be utilized to help determine the risk for suicide; such questions in the tool can be used as part of the database. According to Cao et al. (2021), valuable data can be gathered by asking questions like the following: Have you been feeling down, depressed, irritable, or hopeless? Have you had little interest in doing things? Have you had trouble sleeping, staying asleep, or sleeping too much? Have you had an appetite? Do you feel like you have little to no energy daily? Have you had trouble concentrating on activities like reading, watching tv, or doing schoolwork? Have you had any thoughts where you feel like you are better off dead? Have you had any thoughts of wanting to hurt yourself? Has there been a time in the last 30 days when you had serious thoughts of ending your life? Such questions are imperative to ask to further prevent suicide attempts amongst the adolescent population.       

Reference:

Cao, J., Chen, X., Chen, J., Ai, M., Gan, Y., He, J., & Kuang, L. (2021). The association between resting state functional connectivity and the trait of impulsivity and suicidal ideation in young depressed patients with suicide attempts. Frontiers in Psychiatry12https://doi-org.lopes.idm.oclc.org/10.3389/fpsyt.2021.567976

Keeley, B. (2021). The state of the World’s Children 2021: On my mind promoting, protecting, and caring for children’s mental health. In UNICEF. UNICEF.

Coronavirus pneumonia (COVID-19) is a global reminder of the need to attend to the mental health of patients and health professionals who are suddenly facing this public health crisis. In the last two decades, several medical pandemics have yielded insights on the mental health impact of these events. Based on these experiences and given the magnitude of the current pandemic, rates of mental health disorders are expected to increase. Mental health interventions are urgently needed to minimize the psychological sequelae and provide timely care to affected individuals.

The patient population selected is Schizophrenia in patients over 70 years of age. Mental illness is the second largest cause of burden of disease in America, and it is estimated that 1 in 4 people will experience a mental health condition such as Schizophrenia each year. Serious mental illness (SMI) which includes schizophrenia, schizoaffective disorder, and bipolar disorder, is often debilitating, resulting in impaired ability to engage in functional and occupational activities (J. Du, L. Dong, T. Wang, et al, 2020).

Mental and behavioral disorders are the main cause of disability worldwide. However, their diagnosis is challenging due to a lack of reliable biomarkers; current detection is based on structured clinical interviews which can be biased by the patient’s recall ability, affective state, changing in temporal frames, etc. While digital platforms have been introduced as a possible solution to this complex problem, with two of the most popular being Calm and Headspace. Both of these focus on mindfulness and meditation and are meant to help individuals get support other than from connection to a Clinician, therapist or other traditional mental health services (J. Du, L. Dong, T. Wang, et al, 2020).

The standard psychiatric history and examination with information from third-party sources contains all the elements of a modern risk assessment. Information about past psychiatric history is also important because it indicates to the clinician the client’s pattern of coping, the coping skills that have been used in the past and how successful they have been, and the coping abilities that the client needs to develop.

References

J. Du, L. Dong, T. Wang, et al. (2020). Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan Gen Hosp Psychiatry (April 3 2020), 10.1016/j.genhosppsych.2020.03.011

J. Du, L. Dong, T. Wang, et al. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed Lancet Psychiatry, 7 (2020), pp. 228-229, 10.1016/S2215-0366(20)30046-8

Introduction

A database is an organized systematic collection, manipulation, and electronic storage of data. Medical data found in the Electrical Health Record database include numerical and diagnostic related information such as flow sheets and medication records. The United States Preventative Services Task Force (USPSTF) health screenings database helps providers with the recommendations for the management of Diabetes mellitus. The diagnosis of diabetes Mellitus and adequate health coaching assist patients and their loved ones understand their risk for developing complications as a result of DM before symptoms are present (Grant, R, W., Anjali, G. 1., & Jaffe, M. G., 2021).

Center for Medicare and Medicaid also require health care providers to use the non-invasive screenings with Hemoglobin A1c (HBAIC) and laboratory glucose levels monitoring stored in the database to identify at-risk patients for developing DM (Grant, et.al, 2021).

Types of Diabetes Mellitus:

Diabetes Mellitus Type 1: In patients with diabetes type 1, their body does not produce insulin. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. This condition starts from Juvenile age. If managed appropriately, the chronic disease condition transition into adulthood (Grant, et.al, 2021).

Diabetes Mellitus Type 2: Type 2 diabetes starts at the age of 18 years old. It is the most common form of diabetes where the pancreas does not produce enough insulin. With healthy eating and exercise, some patients can control their blood sugar levels, while others may need medication or insulin to help manage it (Grant, et.al, 2021).

Pre-Diabetes: Patients with prediabetes, may have it and not know it due to there being no clear symptoms. Before patients develop type 2 diabetes, they have blood sugar levels that are higher than normal but not yet high enough to be diagnosed with diabetes. Laboratory findings with glucose monitors and HBAIC assist providers to make differential diagnoses and identify at-risk patients because the treatment regimen depends on the type of DM (Grant, et.al, 2021).

Diabetes Mellitus from other causes: Some patients develop Monogenic diabetes syndromes such as maturity-onset diabetes of the young (MODY). MODY is diabetes type 2 seen in young children due to the high rise in obesity and lack of physical activities. Drug or chemical-induced diabetes is seen in patients on glucocorticoids for treatment of HIV/AIDS or after organ transplantation (Grant, et.al, 2021).

The elements I think will be valuable for diabetic patients in a database includes but are not limited to flow sheet and medication record

Flow Sheet Record: Flowsheet vital signs database documentation monitors that are important to diabetic patients include, blood pressure, glucose level, weight, and body mass index (BMI). Obesity is one of the predictors of Insulin resistance seen in patients with DM type 2. Monitoring of blood glucose can be done at home using finger sticks or through laboratory monitors. With regular blood glucose monitoring and insulin therapy, patients can learn how to maintain an adequate glycemic index, manage their condition at home, and live long, and healthy lives. The database flow sheet keeps a record of Lipid profile, weight, blood pressure, and HBAIC which if abnormal and not managed appropriately with diabetic patients may lead to complications of cardiovascular disease, stroke, and peripheral artery disease. Patients with DM require to be placed on Cholesterol medications and blood pressure medication for cardiovascular and reno-protection respectively (Grant, et al, 2021).

Medications Record: Diabetes causes the body to have too much glucose in the bloodstream. The body uses oral Hypoglycemic medications and Insulin (a hormone produced in the pancreas) to convert blood glucose to energy in the cells. Diabetic patients need to be monitored closely for compliance with medical management. Non-compliant DM patients risk the probability of microvascular and macrovascular complications of Coronary Artery Disease, Neuropathy, and early mortality (Grant, et al, 2021). Despite USPSTF’s convincing evidence supporting guidelines for a lifestyle change and medication management, progress in the control of diabetes-related risk factors such as Hypertension, Dyslipidemia, Diabetic Nephropathy, and Hyperglycemia in some cases has worsened (Grant, et al, 2021). Patient data stored in the database assist providers with frequent adjustment and medication reconciliation based on patients’ needs and tolerance (Grant, et al, 2021).

Reference

Brugnara, L., Novials, A., Ortega, R., De Rivas, B. (2018). Clinical characteristics, complications, and management of patients with type 2 diabetes with and without diabetic kidney disease (DKD): A comparison of data from a clinical database. In Endocrinología, Diabetes y Nutrición (English ed.). V65(1):30-38. Retrieved from DOI: 10.1016/j.endien.2017.10.010

Grant, R, W., Gopalan, A. 1., & Jaffe, M. G. (2021). Updated USPSTF Screening

Recommendations for Diabetes: Identification of Abnormal Glucose Metabolism in Younger Adults. JAMA Intern Med. V181(10). pp1284-1286. Retrieved from DOI: 10.1001/jamainternmed.2021.4886

REPLY

Database are extremely important for data collected and looking at the impact that interventions have on outcomes. One population where databased are foundational in trauma patients in trauma centers. This is a requirement for designation as a trauma center by the American College of Surgeons. For the database there are some very important components to track and trend. This has been shown to decrease mortality from trauma and decrease the disparities between high and low income countries (Grant et al., 2021). Below are just a few of the elements collected:

·     Age-number

·     Gender-categorized text

·     Mechanism of Injury- categorized text

·     Date of injury- date

·     Time of injury-time

·     Vital signs (BP, HR, SPO2, Temp, and Pain)-numbers

·     Glasgow Coma Score-number

·     Time of physician evaluation-time

·     Time that imaging began-time

·     Disposition-categorized text

This national database allowed for performance comparison to identify areas of opportunity. This also allow for easy tracking and trending of your own facility data. This is all is vital to the Performance Improvement Plan(PIP). The PIP the truly the foundation of a trauma program. The reason that trauma designation exists is to improve the quality of care for the trauma patients that present to the emergency department regardless of designation.

Reference

Grant, C. L., Tumuhimbise, C., Ninsiima, C., Robinson, T., Eurich, D., Bigam, D., Situma, M., & Saleh, A. (2021). Improved documentation following the implementation of a trauma registry: A means of sustainability for trauma registries in low- and middle-income countries. Injury52(9), 2672–2676. https://doi-org.lopes.idm.oclc.org/10.1016/j.injury.2021.07.030