Carry out a meta-analysis on high-dose versus low-dose opioid use during anesthesia for cardiac surgery in adults.

The article that I chose to review is a meta-analysis on high-dose versus low-dose opioid use during anesthesia for cardiac surgery in adults. According to Rong et al. (2019), high-dose opioid administration has been the mainstay during cardiac anesthesia for decades because of its ability to preserve hemodynamic stability and diminish hormonal and metabolic responses to surgical stress. However, high-dose opioid administration can potentially result in prolonged ventilation for patients postoperatively (Rong et al., 2019). In the more recent years, synthetic opioids such as fentanyl and remifentanil have replaced previously used opioid medications such as morphine during cardiac surgery due to their shorter duration of action and improved side effects (Rong et al., 2019). Furthermore, recent evidence indicates that increased opioid use during cardiac surgery may lead to an increase in post-operative pain medication requirements for patients during the immediate recovery phase as well as long-term (Rong et al., 2019). Therefore, this analysis specifically focuses on comparing in-hospital outcomes of high-dose and low-dose opioid anesthesia for adults undergoing cardiac procedures.

I think that this article demonstrates high quality research. The research was designed as a systematic review and meta-analysis of randomized controlled trials. This type of design categorizes the research as level 1a evidence according to the Oxford Centre for Evidence-Based Medicine (2009). The design of this research is appropriate and beneficial because previously no meta-analysis had been completed comparing high dose and low dose opioid administration specifically during anesthesia for patients undergoing cardiac procedures (Rong et al., 2019). The methods of the research were in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as well as the Meta-Analysis of Observational studies in Epidemiology (MOOSE) guidelines (Rong et al., 2019). Likewise, this analysis used multiple appropriate statistical analysis approaches to ensure accuracy of results. A random effect model was used to compare outcomes of interest within the studies and the standard mean difference was estimated (Rong et al., 2019). Additionally, the I² and Tau² tests were used to determine inter-study heterogeneity and a leave-one-out sensitivity analysis was performed if significant heterogeneity was detected (I² > 75%) (Rong et al., 2019). Importantly, the authors did perform a meta-regression analysis to ensure there was no effect from age, gender, or type of opioid used between the studies. This meta-analysis utilized a large patient sample by including eighteen studies for a total of 1400 patients undergoing cardiac procedures (Rong et al., 2019). Of the eighteen studies, seventeen were randomized controlled trials and one was an observational study (Rong et al., 2019). The article also provides a chart that identifies all eighteen studies included with details on procedure type, medication use, and patient samples. By using a large sample size, the meta-analysis results have increased statistical power.

The results of this meta-analysis found similar safety and efficacy between low-dose and high-dose opioid anesthesia for patients undergoing cardiac surgery. Initially, no difference was found in postoperative ventilation time between the two groups, however, after one study was excluded based on significant heterogeneity, there was a trend to shorter ventilation time in the group using low-dose opioid anesthesia (P=0.05) (Rong et al., 2019). Furthermore, the analysis found no significant differences in secondary outcomes between the groups related to perioperative hypotension, vasopressor requirements, perioperative myocardial infarction, or perioperative strokes (Rong et al., 2019).

This meta-analysis is applicable to clinical practice as it suggests that low-dose opioid anesthesia can be just as effective as high-dose opioid anesthesia for patients undergoing cardiac surgery. By using lower doses of opioid medications, patients may experience fewer of the postoperative complications associated with opioid use such as nausea and vomiting, delayed emergence, delayed bowel function return, and increased length of stay (Rong et al., 2019). By being educated on these findings, providers can adjust their practices to reduce cost and potentially improve recovery times and overall outcomes for patients undergoing cardiac surgical procedures.

References

Rong, L. Q., Kamel, M. K., Rahouma, M., Naik, A., Mehta, K., Abouarab, A. A., … Gaudino, M. (2019). High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A meta-analysis. Journal of Clinical Anesthesia, 57, 57–62. https://doi.org/10.1016/j.jclinane.2019.03.009

University of Oxford. (2020, October 1). Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.

What is your vision for the future of informatics in nursing practice?

Description

What is your vision for the future of informatics in nursing practice? Paper is to be written in APA style with Abstract, Keywords, and Conclusion . Paper is to be written from a registered Nurse perspective.

Analyse the demographic, political and social processes that cause changes in Exxon Mobil.

1. Analyse the demographic, political and social processes that cause changes in Exxon Mobil. [800 Words]
   1. Explain the influence of globalization (any three) on the home country of Exxon Mobil.        Max 300 words
   2. Is there any “Regional” body Exxon Mobil belongs to. If yes, what are the pros and cons of being a member to such a body. If not, discuss the pros and cons of not being a member to any regional body. Max 300 words
   3. What measures will you take to bring a global culture in Exxon Mobil ?                             – Max 200 words

References: You should use the Harvard Referencing System (HRS) correctly throughout in your report.

Discuss how the organization would cope with the challenges of expatriate management of the employees of the chosen organization relocating to various locations around the world

1. Discuss how the organization would cope with the challenges of expatriate management of the employees of the chosen organization relocating to various locations around the world (choose two different countries where your employees would be relocating with their spouse and children). [1100 Words]
   1. Highlight the challenges of expatriate management for Exxon Mobil for two potential countries of your choice other than the home country of Exxon Mobil. – Max 400 words
   2. Discuss the possible pathways to cope with such challenges exploring best practices in expatriate management. Max 400 words
   3. For hiring, which IHRM orientation would you prefer for Exxon Mobil and why?                  Max 300 words

Critically evaluate how globalization has affected the inequalities in various countries in the 21st century world

1. Critically evaluate how globalization has affected the inequalities in various countries in the 21^st century world (you may choose three or more countries around the world). [1100 Words]
   1. Create a comparison among the three countries using the determinants of inequality           Max 400 words
   2. Explain any two models from research focused on determinants of inequality. (10 Marks)- Max 400 words
   3. How can Exxon Mobil extract benefit from the inequalities of globalization. Max 300 words

Evaluate how drivers of globalization in the 21st century has affected Exxon Mobil and the people of your country.

How will you determine the types of support needed by the adult learners in your system?

Description

In a post of 300-500 words, answer the following: 1. Prior to the discussion, complete the Assessing Ways of Knowing Chart. 2. How will you incorporate the tenets of adult learning theory into the professional development you will design in your role as a system leader? 3. How will you determine the types of support needed by the adult learners in your system?

How did the concept of deduction set ancient Greek mathematics apart from ancient Egyptian mathematics?

What motivation factors may influence safety behaviours of staff in this organisation that contribute to fatal injuries at workplace?

MSc Safety and Risk Management

Research Proposal

Issue brief for research proposal:

Over the last 10 years, the annual statistics on lost time injuries in various sectors of petroleum development Oman (PDO) indicate that the highest rate is directly attributable to human factors. Why do you think this is? What motivation factors may influence safety behaviours of staff in this organisation that contribute to fatal injuries at workplace?

Petroleum development Oman (PDO) has issued HSE guidance on various aspects. Look at this guidance and discuss whether you think that it addresses the psychological motivators you have identified.

Country of research: Sultanate of Oman

Region of study/Company: Petroleum Development Oman (PDO)

Website: Home (pdo.co.om)

You should prepare a Research Proposal with an approximate length of 2000 words (+/- 15%). The research proposal should be in relation to the topic that you plan to complete for your MSc dissertation. You may need to re-visit the guide documents: G1 – A Guide to Writing Aim and Objectives, and Structuring Coursework and; G2 – MSc. A Guide to Writing a Research Dissertation.

The following framework must be used to structure the Research Proposal:

– Title

– Introduction

– Literature review

– Proposed research methodology

– Conclusion

– References

– Bibliography (if required)

Guidance

1. Title

The title should accurately reflect the contents and context of the research proposal. The exact wording of the title should give you and the reader a broad focus for the dissertation.

2. Introduction

In this section, you should provide a summary (approx. 500 words) on what your proposed research is.

Organisational background

It should begin with a brief background to the organisation and how this relates to the study.

Rationale

You should expand on your title to outline what question you want to address, consider or answer – what is the primary issue? You should also detail why this matters, why do you think it is worth investigating? For example, how will your proposed research add to knowledge in your chosen area? Why will the proposed dissertation be of interest and value to academics and practitioners? Does your research intend to fill a gap in existing literature, add to existing literature or conflict with existing literature? What do you hope to achieve through your research? Whilst your personal motivation is relevant and can be noted, it is important that you outline the empirical evidence to support these answers. The proposal should be written in the 3rd person throughout.

Aim and Objectives

The introduction should also clearly outline your aim and corresponding objectives for the proposed dissertation. Your aim should set out in broad terms what you hope to achieve through your dissertation (It must be related to the research topic and encompass the whole Dissertation). Your objectives then need to be specific and detail the actions that you will take to achieve your aim. There must be 5 to 7 objectives for the dissertation.

3. Literature Review

This section should indicate to the reader what is already known about your research subject. It should be approximately 1,000 words in length and will be the main component of your research proposal. You need to demonstrate to the reader that you are familiar with existing knowledge in your subject area. You should detail how your proposed research will link with the existing literature. This will will require you to identify relevant literature, and key concepts within that can then be synthesised to provide you with conclusions. To help structure your literature review, you could use your objectives as sub-headings. This section should include extensive citation with critical evaluation and discussion of the identified content.

4. Proposed research methodology

This section should provide a summary of what research methodology you intend to use. Consider how you will collect data and how you will analyse it. For example, do you envisage using a qualitative, quantitative or mixed method approach? How will this be applied in the research and what is the anticipated timescale? Importantly, consider if your intended approach aligns with your overall aim for your research. One of your objectives should relate to your methodology. You should also provide relevant citation to support the methodological choices being made.

5. Conclusion

Students should provide a summary paragraph restating how the findings from the Literature Review apply to the organisational issue to be studied, and how the methodology to be adopted will help meet the research Aim and Objectives.

6. Bibliography / References

Strathclyde Harvard referencing should be used. Your research proposal is expected to encompass appropriate and sufficient citation.

Note: Please use the uploaded specific university guide for referencing.

construct and advance a clear, coherent and logical ‘argument’ that leads to sound or cogent conclusions

The Research Question (RQ) or Aim/Objectives Approaches to Structuring an Activity, Assignment or Dissertation Submission • Critical Analysis: The fundamental requirement of MSc study is for the student to show robust and in-depth critical analysis, which is considered the higher cognitive skill expected at this educational level. In practice, what this means is that the student must show they can o analyse and evaluate research literature (citing appropriate papers); o undertake methodologically sound research that facilitates the critical analysis of a specific issue; o construct and advance a clear, coherent and logical ‘argument’ that leads to sound or cogent conclusions [in academia, an ‘argument’ is any work proffered for assessment or critique, e.g., the whole Assignment or Dissertation]; and o in SRM, apply the analysis in an occupational H&S context. Students have a relatively short period and word count in which to address all the aspects above. A significant problem is usually the need for in-depth critical analysis; students try to cover many factors of potential relevance to their research, which, given the word count constraints, can lead to a superficial analysis of the more significant elements. • Research Questions (RQs) give an idea of the problems a student might be thinking of tackling in their Activity, Assignment or Dissertation (AAD). At the early stage of researching an AAD, think of RQs as being relatively random questions that might need further consideration; they might be amended, re-ordered and changed in the future. The very fact that a student might think about many RQs can lead to a loss of focus, resulting in an incoherent and illogical argument being proffered. An Aim and Objectives approach to structuring submissions tries to avoid this common pitfall. • Social science research can utilise the RQ approach without explaining how the questions fit into the ‘structure’ of the AAD submission. For the MSc in Safety and Risk Management (SRM), the ‘structural’ approach to Assignment and Dissertation work requires the inclusion of an Aim and Objectives (A/Os). Within this A/O-based framework, Research Questions can often confuse students when seeking to structure an AAD in a focussed and coherent academic manner; the difference between an RQ and an Aim or Objective may not be apparent. • Consequently, for SRM purposes, within the Aim and Objective approach, it is considered that Research Questions are NOT required. Research Questions represent issues upon which students might want to focus. This helps them ‘tighten’ the scope of the Aim or Objectives, and students are advised to utilise them in this manner. How to do this will become apparent later (see Literature Mapping in Part 2, s.1). • Thus, students are advised to concentrate on developing a suitable Aim. From the Aim, a set of Objectives will then be derived as a framework for the chronological development of the student’s ‘argument’ (submission) to meet the AAD requirements.