Tuberculosis

Assignment #1: Research Proposal Topic

The purpose of this research paper is to offer a detailed analysis and answer to the medical problem posed by tuberculosis, as well as to understand the impact that this problem has on nursing practices. The following five research questions are put forth using the PICO format, and as such represent a strong basis of further research that can be conducted.

Chosen Research Question: In a population of elderly tuberculosis patients, what is the effect of treatment protocols and modern medicine on survival rates when compared to no treatment? 

Research Question 1:

In a population of adults and children, what is the effect of proper fluid intake on treating tuberculosis when compared to no treatment?

This question is simple in its goal, which is to establish the extent to which adequate fluid intake is necessary in patient recovery rates of tuberculosis. Tuberculosis requires sufficient fluid intake in order to fight off the disease, which helps to explain the preponderance of heavy liquid-based diets during the period of time in which the patient is attempting to stabilize and recover.

Research Question 2:

In a population of infants, what is the effect of tuberculosis vaccination on preventing tuberculosis when compared to no vaccination? 

This question is designed to analyze the practical benefits and effects of vaccinations of infants for tuberculosis, and to determine whether or not the downsides (if any) of infant vaccination outweigh the benefits of the procedure. 

Research Question 3:

In a population of adults, what is the effect of antibiotics on treating tuberculosis, when compared to no treatment?

This question is aimed at understanding the effects of antibiotics when it comes to treating tuberculosis. Moreover, this question seeks to understand the ways in which antibiotics factor into the matter of effective treatment of patients.

Research Question 4:

In a population of treated and cured tuberculosis patients, what is the effect of drug-resistant TB strains on post-primary infections when compared to a population that has never experienced the infection?

This question aims to understand the ways in which drug-resistant strains of tuberculosis affect populations of patients that have either recovered from the primary disease or have never experienced the disease at all. In short, this research question hopes to gain understanding of the problem of drug-resistant tuberculosis and the ways in which the disease is evolving to become a new health hazard in the 21st century. 

Research Question 5:

How do patients diagnosed with HIV perceive an outbreak of tuberculosis infection?

This question attempts to understand the relationship between HIV/AIDS and tuberculosis, particularly in the developing world. Moreover, this question aims to understand the ways in which an HIV diagnosis can create difficulties for tuberculosis patients, particularly with complications arising from medication, treatment, and a weakened immune system. 

Keyword selection:

1. Tuberculosis: as the primary point of study of this research paper, an understanding of tuberculosis is necessary. 

2. Drug resistance: Drug-resistant tuberculosis is important in understanding how medications and treatments will have to change in order to combat the new disease.

3. Vaccinations: Vaccinations are important in understanding the health benefits of prevention and treatment. 

3. Antibiotics: Antibiotics allow for the modern treatment of tuberculosis to occur, and are important for this reason. 

4. HIV/AIDS: HIV/AIDS is relevant for understanding the importance of competing medical conditions and potential problems of complications that may arise. 

5. Adult populations: Adult populations are defined in this research paper as the age group of 18-45, with any patients older deemed “elderly” and any younger as “young adults/infants”.

6. Infants: Infants are an important population group for this study.

7. Tuberculosis treatment: Obtaining research that shows how tuberculosis is treated is critical for this study.

8. Tuberculosis prognosis: Understanding the dangers of a tuberculosis prognosis, with or without treatment, is important for this study. 

9. Tuberculosis epidemiology: Understanding the patterns, causes, and effects of tuberculosis is hugely significant, given that understanding the problem can lead to treatment and prevention protocols. 

10. Tuberculosis outbreaks: Prevalence and commonality are important factors in understanding the disease.

Assignment #2: Research Proposal and Literature Review

PICO Question: In a population of elderly tuberculosis patients, what is the effect of treatment protocols and modern medicine on survival rates when compared to no treatment? 

Abuaku, B., Tan, H., Li, X., Chen, M., & Huang, X. (2010). Treatment default and death among tuberculosis patients in Hunan, China. Scandinavian Journal of Infectious Diseases, 42(4), 281-287. 

This study showcases national data from China that deals with tuberculosis (TB) patients in China. It deals with the “risk factors for treatment default and death from TB” in the Hunan province of China. The data shows that death rates are lowest in patients in the age group of 15-24 years of age and increases with age. It concludes that male TB patients, especially elderly ones, are at the most risk for dangerous TB complications.

Cruz-Hervert, L. P., García-García, L., Ferreyra-Reyes, L., Bobadilla-del-Valle, M., Cano-Arellano, B., Canizales-Quintero, S., . . . Ponce-de-León, A. (2012). Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes. Age & Ageing, 41(4), 488-495. 

This study the impact of TB on young adults. It concludes that “ community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasize the need for specific strategies for this vulnerable group.”

Kida, Y., Minakata, Y., Yamada, Y., & Ichinose, M. (2012). Efficacy of Noninvasive Positive Pressure Ventilation in Elderly Patients with Acute Hypercapnic Respiratory Failure. Respiration, 83(5), 377-382. 

This study focuses on the use of “ efficacy of noninvasive positive pressure ventilation (NPPV) in elderly patients.” The study shows that patients that are above “75 years of age” and have “acute hypercapnic respiratory failure” are at the most risk for TB death overall. However, the paper shows that treatment with NPPV can be very effective in reducing elderly deaths from TB. 

Millet, J.-P., Orcau, A., Rius, C., Casals, M., de Olalla, P. G., Moreno, A., . . . Caylà, J. A. (2011). Predictors of Death among Patients Who Completed Tuberculosis Treatment: A Population-Based Cohort Study. PLoS ONE, 6(9), 1-8.

This study shows that mortality among patients that completed TB treatment is still quite high. The research conducted concludes that “The mortality rate among TB patients who completed treatment is associated with vulnerable populations such as the elderly, alcohol abusers, and HIV-infected IDU”. The paper then goes to argue that TB deaths can be prevented if, and only if, certain risk factors are removed. The need to fight against poverty and the necessity of social programs aimed at reducing TB deaths are necessary.  

Pardeshi, G., & Deshmukh, D. (2007). Disease Characteristics and Treatment Outcome in Elderly Tuberculosis Patients on DOTS. Indian Journal of Community Medicine, 32(4), 292-294. 

This article argues that disease characteristics and treatment outcome in elderly patients can be reduced by the use of Directly Observed Therapy Shortcourse (DOTS).  As the “death rate was significantly higher in the elderly than the control group on category III DOTS regimen”, the paper then discusses “some of the factors for the increased death rate in the elderly are diagnostic problems and concomitant illness.”

Schaaf, H. S., Collins, A., Bekker, A., & Davies, P. D. O. (2010). Tuberculosis at extremes of age. Respirology, 15(5), 747-763. 

This paper shows how the extreme ends of the age spectrum are vulnerable to TB. Though the disease strikes down many young adults, people that are either very old or very young are at risk, especially in the developing world. The paper argues that “public health measures to prevent transmission of infection; identify those infected and providing preventive therapy; high index of suspicion in order to make an early diagnosis; and timely initiation of treatment are important in both the very young and the elderly.”

Van den Brande, P. (2005). Revised Guidelines for the Diagnosis and Control of Tuberculosis: Impact on Management in the Elderly. Drugs & Aging, 22(8), 663-686. 

This paper analyses the reasons why TB is still a difficult disease to treat, even with modern medicine. The paper argues that “elderly persons infected with tuberculosis at the beginning of the 20th century constitute a large reservoir of latent tuberculosis infection”, and are also at risk for subsequent infections and outbreaks of the disease. 

Yong Soo, K., Su Young, C., In Jae, O., Kyu Sik, K., Yu Il, K., Sung Chul, L., & Young Chul, K. (2013). Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case-control study. BMC Infectious Diseases, 13(1), 1-7.

This study aims to evaluate the “differences in clinical characteristic and treatment outcomes between older and younger TB patients” in South Korea. The paper concludes that “older TB patients had more frequent dyspnea and less frequent active TB findings on chest CT” and that “treatment success and adverse drug reaction rates were similar in older and younger TB patients”.

Assignment #3: Conceptual Framework 

The research question is as follows: “In a population of elderly tuberculosis patients, what is the effect of treatment protocols and modern medicine on survival rates when compared to no treatment?”

Introduction: The problem, then arises, in creating a conceptual framework that can answer this question. Defining the problem is simple, albeit it becomes more difficult to answer. First, there is the problem of finding an unbiased sample population that has received treatment and the problem of finding a population that it can be compared to. 

Significance of the Problem: 

In a study of tuberculosis (TB), it becomes abundantly clear that TB affects senior citizens at rates that reflect the vulnerable position of that population. Millet (2011) argues that the “mortality rate among TB patients [...] in vulnerable populations” such as the elderly are higher than young adults and infants, and that elderly represent a major population vulnerable to post-primary infections and outbreaks. These statements are supported by Schaaf (2010) and Ven den Brande (2005). Abuaku (2010) supports this indirectly, primarily through his emphasis that young adults from 15-24 have the lowest death rates overall.

However, Yong Soo, (2013) holds that, while mortality rates may be similar, treatment options are usually equally as effective between age groups. This is a possible contradiction, but it can be argued that differences in death rates between elderly and young adult patients can largely be due to the preponderance of elderly patients to experience the infection. I would argue that there is sufficient research to indicate that care of elderly patients should be the focus of nursing efforts aimed at ensuring health benefits for all individuals involved. 

Process of Literature Review: 

Academic Search Complete, the American Journal of Nursing, Nurses Journal from Medscape, and the Journal of Professional Nursing provided the information for this research paper. The research literature was limited to articles and studies that only approached the matter of elderly patients. All ten keywords were used to establish a database of research to draw upon, with some 875 total articles yielded. 

Conceptual Framework: 

I hold that in a population of elderly tuberculosis patients, the effect of treatment protocols and modern medicine on survival rates when compared to no treatment is that rates of recovery and survival will increase dramatically. As per Schaaf’s research and others, the mortality rate of elderly patients is some six times higher than other population age groups. I aim to determine whether or not this is a result of the disparate rates of TB outbreaks in elderly populations, or whether TB itself is more likely to result in the death of an elderly patient when compared to a younger adult. Though adults have easier times of fighting off the infection, the difficulty comes with the issue of whether or not elderly people die more often from TB because of their age, or instead that more elderly patients die because of their increased chance of contracting the disease. Thus, with the research question in mind, we can begin to create a conceptual framework that allows for increased understanding of the ways in which elderly patients respond to treatment vs non-treatment, and thereby allow an understanding of the ways in which different treatment protocols offer different approaches towards recovery and survival. 

Assignment #4: Research Proposal: Purpose, Question, Hypothesis, Independent and Dependent Variables, and the Operational Definitions

The research questions are as follows: “In a population of extreme elderly (ages 75 and over) tuberculosis patients, what is the effect of treatment protocols and modern medicine on survival rates when compared to no treatment?”

In this, my hypothesis is that elderly patients that have proper care and treatment for tuberculosis will experience a moderately higher rate of TB recovery, though the overall mortality rate will nonetheless be far higher than in lower age groups. I argue that this is because patients at the extreme end of the age spectrum, despite their level of care, represent an increasingly vulnerable population overall. Moreover, this statement is supported by various research, including Cruz-Hervert (2012), Pardeshi (2007), and Schaaf (2010). Schaaf, in particular, holds that extreme age, both infant and elderly, is the single most vulnerable patient population for fatalities from TB. For this research study, the independent variable would be the level of care that an elderly patient receives, qualified in terms of a scale of 1-5, with the care of one being minima or non-existent, and with 5 being a fully developed and professional hospital setting. The dependent variable would be the relative death rates and survival rates of elderly patients (ages 75 years and over).