IPE 315 EBP Proposal Part 1

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Valparaiso University *

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315

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Civil Engineering

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Oct 30, 2023

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IPE 315 EBP Project Part I due Sunday, October 18 Part II due Friday, November 6 Final Proposal due Tuesday, November 17 Group Members: Lillia Pogue, Tyler Bush, Emily Osowski, Morgan Pickens, Tricia Pryor, Isaac Velasco, Sarah Mears Topic: Promoting alcohol cessation in adults to prevent fetal alcohol syndrome Part 1 instructions are in the Assignments tab on Blackboard → use this to guide you in completing your part! Responsibilities for Part 1: Lillia: background (definition of fetal alcohol syndrome, pathophysiology or case definition, morbidity (signs and symptoms disease, mortality rate, prevalence rate) Tyler: Intro (hook) Emily: background (population-Is there a specific population that this problem seems to affect most? Is there a setting, location, or situation in which this problem seems really common or severe? Impact of the disease on your specific population. ) Morgan: question & hypothesis Tricia: intro (thesis) Isaac: question and hypothesis Sarah: background How Is the EBP Proposal Graded? A standard rubric will be used to grade all sections of the EBP Proposal. The overall EBP Proposal is worth 25% of your final grade, and points will be distributed as follows: · Part I: Problems, Questions, and Hypotheses (20%) o Describe the background of your clinical problem and propose a focused clinical question (PICOT) to guide your EBP project. Clearly state the study hypotheses. · Part II: Outcome Measures, Intervention, and Study Design (35%) o Choose the measures you will use for your project variables. For all questionnaires and diagnostic tests, you will need to report information about their reliabil ity and validity. o Based on your literature review, refine the intervention you will use to address your clinical problem. Also, propose the design you will use for your EBP project. · Final Proposal (30%) o Identify the analysis plan for your project variables, including descriptive and inferential statistical tests.

o Combine your information from Part I and Part II into one document, incorporate any revisions that Professor Li has suggested along the way, and submit the final draft of your EBP project proposal. · Peer evaluation (15%) · Each student’s participation and preparation for the group project will be evaluated by other students within the group. · All students within the EBP Proposal Group will receive the same score on part I, II and final proposal except for peer evaluation. All students in the group must participate. Intro Hook : Fetal alcohol syndrome presents a multitude of adverse health effects seen in children born with the condition, including mental, physical, and psychological dysfunctions that persist throughout one’s life. Alcohol consumption in pregnant women is easily preventable with proper health interventions; however, health professionals are unaware of the exact mechanisms that contribute to the variance of symptoms in children. Thesis (this was hard to write without the background info so please feel free to change it as you see fit) Alcohol cessation during pregnancy decreases FAS in children thus resulting in better lives for the children, This paper discusses the dangers of alcohol consumption during pregnancy including cost, mortality and morbidity, adverse effects of children born with FAS, as well as possible interventions to end alcohol consumption while pregnant. Question & Hypothesis: In adult patients that consume alcohol during pregnancy, what are the effects of support groups, behavioral therapies, and medication interventions on preventing fetal alcohol syndrome compared to no interventions during pregnancy? Having said this, if interventions, such as support groups, behavioral therapies, and medication interventions are implemented, then the number of alcohol absent days will increase among adult patients, the child of the mother will have improved health outcomes, and the child will have a decreased chance of being born with FAS. Background (Lillia) Fetal alcohol syndrome is a group of conditions that can occur in a person whose mother

consumed alcohol during pregnancy (Fetal Alcohol Spectrum Disorders, Cause and Prevention [CDC], 2020). A person with fetal alcohol syndrome could experience low body weight, poor coordination, hyperactive behavior, difficulty with attention, poor memory, difficulty in school, learning disabilities, speech and language delays, intellectual disability or low IQ, poor reasoning and judgment skills, sleep and sucking problems as a baby, vision or hearing problems, problems with the heart, kidneys, or bones, shorter-than-average height, small head size, abnormal facial features, such as a smooth ridge between the nose and upper lip (Fetal Alcohol Spectrum Disorders, Signs and Symptoms [CDC], 2020). People with FAS have problems with their central nervous system, minor facial features, and growth problems. FAS case mortality rate is 2.4%, and t he most recent CDC study analyzed medical records and found FAS in 0.3 out of 1,000 children from 7 to 9 years of age (Burd et al., 2008). Studies using in-person assessment of school-aged children in several U.S. communities report higher estimates of FAS - 6 to 9 out of 1,000 children (Fetal Alcohol Spectrum Disorders, Prevalence [CDC], 2020). Data & Statistics. (2020, July 06). Retrieved October 18, 2020, from https://www.cdc.gov/ncbddd/fasd/data.html Basics about FASDs. (2020, May 07). Retrieved October 18, 2020, from https://www.cdc.gov/ncbddd/fasd/facts.html Burd L;Klug MG;Bueling R;Martsolf J;Olson M;Kerbeshian J;. (n.d.). Mortality rates in subjects with fetal alcohol spectrum disorders and their siblings. Retrieved October 18, 2020, from https://pubmed.ncbi.nlm.nih.gov/18338392/ Background (Emily) Background (Sarah) Possible Interventions: ● Screening ● Brief Intervention, Motivational Interviewing ● Support Groups ● Behavioral Therapies (Cognitive and Motivational) ● Medications Intervention Details: ● Screening ○ Important to reduce alcohol misuse → helps identify the problem ○ “The CDC, American Academy of Family Physicians (AAFP), and American Congress of Obstetrics and Gynecology (ACOG) recommend that all women of

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childbearing age be screened for alcohol use in order to prevent alcohol-related birth defects” (Zoorob, 2014, p. 83). ○ “The Alcohol Use Disorders Identification Test (AUDIT) was designed by the World Health Organization (WHO) for identifying risky drinking and alcohol dependence in primary care settings and is the most universal tool with high validity and reliability. It consists of 10 multiple choice questions measuring hazardous alcohol use, dependence symptoms, and harmful alcohol use, and it can be completed and scored in 2-4 min” (Zoorob, 2014, p. 83). ● For non-dependent alcohol use: ○ Brief intervention / motivational interviewing ■ “Brief intervention is a face-to-face counseling technique that can be done in 1-4 sessions that last between 5 and 15 minutes and include feedback, advice, resources, and goal-setting. Several randomized controlled trials have found brief intervention to be an effective method for primary care settings in reducing alcohol consumption. A review of studies reported a reduction in alcohol consumption from 13% to 34% among those who received brief intervention” (Zoorob, 2014, p. 83). ○ “The analysis concluded that brief intervention showed benefits at 6 and 12 months of follow-up” (Zoorob, 2014, p. 83). ***too late for 9-month pregnancy! ○ One method for executing brief intervention is the 5 A’s model, which includes: (1) ask about their drinking habits; (2) assess risk level; (3) advise patients about the personal health risks and benefits; (4) agree on an appropriate drinking goal; and (5) arrange a follow-up visit to assess progress (Zoorob, p. 83-4). ○ “Patients who are identified as alcohol dependent may not benefit from brief intervention and will need to be referred to a specialized treatment” (Zoorob, 2014, p. 84). ● For dependent alcohol use: ○ More specialized care → ○ For alcohol dependent individuals: alcohol abuse treatment centers → treatment centers can be identified using the Substance Abuse and Mental Health Services Administration’s phone number or online locator for treatment referral assistance ■ Support groups (self-help) ● Support groups - 12-step support groups (example: AA) ● “The National Organization on Fetal Alcohol Syndrome (NOFAS) provides support for birth mothers… The network includes women with current alcohol addiction, those in recovery, and those who have not suffered from addiction but who drank alcohol during pregnancy” (Zoorob, 2014, p. 85). ■ Behavioral therapies (cognitive and motivational)

● “Cognitive behavioral therapy helps identify high-risk situations, teaches strategies to cope with those situations, and deals with alcohol cravings” (Zoorob, 2014, p. 85). ● “Motivational enhancement uses the patient’s own resources to change behavior” (Zoorob, 2014, p. 85). ■ Medications for treatment ● Naltrexone → helps suppress alcohol cravings ● Acamprosate → reduces symptoms during abstinence ○ Using both during treatment in conjunction with brief intervention was the most effective (Zoorob, 2014, p. 85). ○ Utilized separately, all resulted in better outcomes, buy acamprosate had the smallest effect on the desired outcome (Zoorob, 2014, p. 85) ○ ***Are these medications safe during pregnancy??? ● “Additional interventions, such as Project CHOICES, have shown positive outcomes when pairing contraception consultation with motivational counseling to assist women with at-risk drinking behavior. Sessions over 12-14 weeks lead to a two-fold risk reduction in alcohol-exposed pregnancies compared to the control group” (Zoorob, 2014, p. 85).