Using Evidence-Base Practice to Formulate a Clinical Question

Introduction

In performing responsibilities of duty, nurse practitioners are faced with situations requiring them to ask some questions. This idea of inquiring will lead to formulation of a question. The question provides a basis upon which the search and research can be done. When inquiry is being used to get the information, the use of database can help get evidence base practice (EBP).

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Caltivation of Spirit of Inquiry

For the research procedure to be put in place, the spirit of inquiry must be present ((Melnyk & Fineout-Overholt, 2015). In the presence of this spirit and determination, the nurse practitioners and the entire medical staff will be able to provide a maximum patient care. With determination and this spirit of inquiry, the medical fraternity will easily adopt the Evidence Based Practice. The essential factors in developing and implementation of Evidence Based Practice are mentors with an understanding of EBP. Nonetheless a process of evaluation that will incorporate EBP, means to search EBP, for example, computers and access to databases. Subsequently recognition of medical professionals that consistently implements EBP, and support from the administration of the medical department.

In the pediriaticts department, care for children falls under the nurse practitioners, whereby, they are also tasked with educating parent and guardians on the medical condition of their children. The nurse practitioners are also the receptors of information from the parents and the children. Due to the diverse roles of the nurse practitioners, the question is pegged towards getting the knowledge on relationship between age and autoimmune infections, and the best therapeutic strategy.

Formulate the PICOT Question

When questions arise for discussion or research, the acronym PICOT is a standard way to format the query. P stands for the population/patient; I stands for the area of interest/intervention, C stands for the comparison/current practice, O stands for the desired outcome and T denotes the time frame (Christenson, 2014).This paper explores at preferred method when treating the children with autoimmune disease as the PICOT question compares the two means of therapy in pediatrics patients.

The question is: The question is: In pediatrics below five years suffering from autoimmune Infection (P), how can administration of plasmapheresis treatment (I) when compared to immunosuppressant dugs (C) help in the treatment of autoimmune diseases (O) from occurring during the child's recovery period (T)?

Plasmapheresis is also known as plasma exchange; this procedure removes the antibodies from the body. In this method, the blood is removed from the body through an intravenous (IV) line. The plasma that has antibodies is given off, and antibody-free blood is taken back to the body along with albumin (Casseta, Ciucci & Galea, 2015). This treatment does not affect the ability of the body to make antibodies, so it provides temporary relief from the autoimmune diseases. Immunosuppressant drugs, on the other hand, are drugs which prevent the activity of the immune system by suppressing the production of the antibodies.

Autoimmune diseases occur when the immune cells attack the host cells they are designed to protect. Plasmapheresis and immunosuppressant drugs have been used for the treatment of autoimmune infections (Raid et al., 2013).

Searching for Evidence

Using the procedure of PICOT question, an intensive research is to be carried out from Cochrane Database of Systematic. The vocabularies to be used include: Plasmapheresis, immunosuppressant drugs, autoimmune infections, IgG, IgM, antibodies, neonates and pediatrics.

Autoimmune diseases occur when the immune cells attack the host cells they are designed to protect. Plasmapheresis and immunosuppressant drugs have been used for the treatment of autoimmune infections (Raid et al., 2013). The adverse effects of plasmapheresis in children include a fall in the arterial blood pressure (8.4%), arrhythmias (3.5%), transient elevation of body temperature and cold sensation (1.1%) (Raid et al., 2013). Most of these symptoms are mild with severe adverse effects occurring in 2.16% of all the procedures performed. On the other hand, side effects of immunosuppressant drugs in pediatric patients include osteoporosis, increase in fractures, reduced muscle strength and hyperglycemic effect.

The immunity of children below five years is low compared to the adults; this is because they have not developed an immune system of their own and are dependent on the mother's immunity. Even when other organs of the body fully develop, the immunity of children is still not fully developed. This is because the immune-globin gamma (IgG) is small and can pass through the placenta to the immune system of the child. The IgG can be responsible for triggering autoimmune infection. At the same time, the child below five years gets the IgM from the breast milk. These antibodies are responsible for causing autoimmune infection in children below five years of age.

Plasmapheresis is done when the body's serum is centrifuged. Because of the centrifugal force, the plasma is filtered out, and the body cells (such as erythrocytes and other colloids) are returned to the body together with the donor's plasma. This is used as a therapeutic approach for many autoimmune infections. The immunosuppressant drugs, on the other hand, can reduce the effect of the immune system. They work by suppressing the activities of antibodies, hence mitigating the reaction that may occur between antibodies and healthy cells. This method is therefore used to treat the autoimmune infection.

Autoimmune infections occur when the body's immune system turns against the harmless cells and start to attack and destroy (Raid et al., 2013). The cause of the autoimmune disease has not been discovered although various theories try to explain it. Some suspect that it is caused by environmental factors, chemical exposure, diet, and/or genetics. It is believed that it is genetically passed because it runs in families. However, members of a genetically predisposed family may never suffer from an autoimmune disease, but in a family where it is present, members are susceptible to various autoimmune infections. Some autoimmune diseases affect only one organ; for example, diabetes Type 1 affects only the pancreas, while others, such as lupus affect the whole body.

Conclusion

The theory that addresses autoimmune disease children below five years of age is called hygiene possession theory. This theory proposes that, due to the presence of vaccines and antiseptic drugs, children are not exposed to as many organisms as they were in the past (Samarghitean, Valiaho, & Vihinen, 2013). Because of this, the immune system does not know what to attack and therefore, it will attack many cells within the body, resulting in an autoimmune infection.

Immunosuppressant drugs and plasmapheresis are used as a therapeutic method for managing autoimmune infections. These two methods frequently represent the first line of treatment considered when formulating a treatment plan for children suffering from an autoimmune infection.

The nurse practitioner should emphasize the best approach to treat autoimmune infections over a seven day period. Most children inherit from the mother "wild" antibodies that may cause infections. Nurse practitioners can utilize the Cochrane database to research studies done, comparing the results and finding the best treatment plans for their patients.

Reference

Casseta, I., Ciucci, G. & Galea, I. (2015) Plasma exchange for multiple sclerosis. HYPERLINK "http://cochranelibrary-wiley.com/o/cochrane/clabout/articles/MS/frame.html" Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group. DOI: 10.1002/14651858.CD008483

Christenson, R., H. (2014) Should we license this test? Practical use of evidence-based laboratory medicine (EBLM) technique. The Cochrane Central Register of Controlled Trials (CENTRAL) . (23)70, 70-70.

Raid, M., Middleton, P., Cossich M., Bain, E. & Crowther, C (2013) interventions for clinical And subclinical hypothyroidism pre-pregnancy and during pregnancy. Journal of HYPERLINK "http://cochranelibrary-wiley.com/o/cochrane/clabout/articles/PREG/frame.html" Cochrane Pregnancy and Childbirth Group. DOI: 10.1002/14651858.CD007752.pub3

Samarghitean, C., Valiaho, J., & Vihinen, M. (2013). Immunodeficiency Information Resources. Primary Immunodeficiency Diseases, 821-832. DOI:10.1002/146019538.CD007665