NUR 545 PNUR 545 Population Health: Analysis and Evaluation week 3 Assignment

Week 3: Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I

Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I

At the end of the week, the student will be able to:

• Identify natural history of disease-cause and prevention.
• Identify the different types of descriptive studies and methods of analysis.
• Describe purpose of analytic epidemiology.

Resources

Cupp Curley, A. L. (2020). Population-Based Nursing Concepts and Competencies for Advanced Practice (3rd Ed.). New York, NY: Springer Publishing Co. ISBN: 978-0-8261-3673-2

• Read: Chapter 3, Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I

For this weeks’ discussion, I picked a case report related to chronic inflammatory demyelinating polyneuropathy (CIDP).  A case report is a “succinct written account of generally rare or unusual cases in which the treatment or management of the disease condition is worth reporting” (Cupp Curley, 2020, p. 72). My coworker’s 14-year-old daughter has this very rare disease and I was interested in learning more about CIDP.  My coworker used the analogy of a thick electrical cord to describe the demyelinating portion of this disease.  Imagine a thick electrical cords’ outer sheath is stripped, therefore affecting the conductivity of the electrical cord inside.  During CIDP, the nerves are stripped of their myelin sheath, consequently affecting the nerves’ conductivity.  CIDP can be described as “an autoimmune disorder predominately affecting the peripheral nervous system (PNS), characterized by muscle weakness and sensory disruption which may involve all four limbs” (Griffith, Munot, Pitt, Prise, Thompson & Bowman, 2019, p. 1). 

Electrophysiological responsiveness to long-term therapy in chronic inflammatory demyelinating polyneuropathy: a case report, is the case report I would like to discuss.  This case report, published in January 2020, presents the “case of a CIDP patient treated successfully with immunosuppression and followed for 31 years with serial standardized clinical and electrophysiological evaluations” (Khomand, Katzberg, Ngo & Bril, p. 40).  This patient was 25 years-old when he presented with a 6-month history of numbness, tingling, fatigue, and limb weakness in 1988.  He was diagnosed with CIDP and treated with steroids and azathioprine.  He improved within 6 months of treatment and continued to improve so much that he was able to play hockey.  At that time, 1993, his steroid was stopped, and the azathioprine was tapered.  The patient relapsed, responded to a higher dose of azathioprine, but when physicians tried to taper off the azathioprine over the years, he would relapse.  In 2005 the patient felt normal and was working full time and running daily.  Azathioprine was slowly tapered and stopped in 2011, and by 2012 his nerve conduction studies (NCS) were normal until he relapsed in 2016 after an upper respiratory tract infection.  The patient received intravenous immunoglobulin (IVIG) and azathioprine.  By 2018, the patient had normal strength, normal sensation and gait, NCS were normal, and azathioprine was discontinued in 2019. 

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Patients with CIPD can be treated with IVIG, subcutaneous immunoglobulin, plasma exchange, corticosteroids and an immunosuppressive drug, azathioprine.  This report found “electrophysiological parameters do improve with treatment in CIDP patients, although the changes can take up to 2 years, and also worsening electrophysiological parameters can herald clinical relapse and might help guide therapeutic decisions” (Khomand, Katzberg, Ngo & Bril, 2020, p. 41).  This patient with CIPD was monitored for more than 30 years showing positive responses to electrophysiology after treatment.  Thus, “electrophysiological assessment can show delayed recovery after clinical improvement and can predict relapse on an individual patient basis” (Khomand, Katzberg, Ngo & Bril, 2020, p. 42).  I hope you all found this disease as interesting as I do, although I am sure there is much more information about CIDP available. 

Case Report Link: https://www.karger.com/Article/FullText/505234 (Links to an external site.)

Cupp Curley, A. L. (2020). Population-Based Nursing Concepts and Competencies for Advanced

     Practice (3rd Ed.). New York, NY: Springer Publishing Co.

Griffith, N. C., Munot, P., Pitt, M., Prise, K., Thompson, D. A. & Bowman, R. (2019). Optic neuritis

      associated with chronic inflammatory demyelinating polyneuropathy in a child – a case report.

      Journal of the Internal Child Neurology Association, 1(1), 1-4.

Khomand, P., Katzberg, H., Ngo, M. & Bril, V. (2020). Electrophysiological responsiveness to long-

     term therapy in chronic inflammatory demyelinating polyneuropathy: Case report. Case

     Reports in Neurology, 12, 40-44.