The first change that Norman implemented was aimed at modifying the managerial structure. This is the introduction of a structure through which the heads of departments are directly answerable to the top manager. This has lead to the downsizing of the number of employees and has eliminated work duplication. From there, a mid-long term plan that covers three years was developed. The first year included redefining the brand and hiring of a new team. Second year included changing the trading style, expansion of business and innovation of new trading ways. The third year plan was of price reductions which positioned Asda as a store which had quality products. It included the finalization of the expansion program (Weber, 1998).
A new strategy has been developed which includes the display of food in the stores for the customers eyes strategically. Commodity prices have been reduced leading to customer attraction. This has brought an upswing of sales, raising hopes that there would be even more price reductions in the near future. The use of Information Technology, design of a different store layout, and innovation are amongst the changes envisioned for the business (Weber, 1998). The next change dimension is through the development a different working system for Asda. In this, the manager and the staff at the stores get to be aware of the store goals and their roles in achieving the same. Great emphasis is directed towards team cohesiveness and setting up of personal goals that are aimed at improving the staff quality. The staff will be trained to develop good relations with the customers. This system is to be known as the Asda way of working.
Company values that has been developed emphasize on respect amongst the staff members, they place more responsibilities on everyone, caution against resource wastage and highlight the need for everyone to better the business. Finally, the introduction of notice boards greatly improved on the store communication. They contain information that help the staff be up to date with the stores past and future goals. Other communication methods like face to face have been slotted in on the new changes that are to be adopted (Weber, 1998).
The program addresses issues regarding the scope and staff awareness of the need for change. The style of change management and the roles of everyone in the changed environment are highly emphasized. The program fits perfectly well with other literature models in regards to the shared values (Hailey & Balogun, 2002).
Leadership is required to tap into the staff diversity of skills and talents. Communication development is a key role that the leadership plays in change. By ensuring face to face interaction as a communication strategy and use of notice boards, the leader develops effective communication. The leaders are responsible for the supervision of the implementation of Asdas best way of working. This means that they have to treat the staff with respect as well as provide them with regular updates. Leaders also have to propose staff training mechanisms and lead by demanding staff performance. Leaders are in charge of the long term goals implementation (Kaufman, 2003).
Change program is effective in turning around a business entitys profit status. It has brough about a leaner system of management and staff thereby reducing on the amount of money that goes to recurrent expense. Change has developed a sense of security for the business. This is important to the financial institutions as loans are easier to secure. The staff members feel like they are part of the store due to the regular communication (Hailey & Balogun, 2002). Business plans for the future and sets up the entity for any upcoming competition and improvement of its market share. What remains to be done is the introduction of a system that collects data in every store. The data will be important in redefining future goals as well as managing resource wastage. Finally, there is need to develop a system that preserves the gains that will be achieved by change (Weber, 1998).
References
Hailey, VH & Balogun, J 2002, Devising Context Sensitive Approaches To Change: The Example of Glaxo Wellcome, Journal of Long Range Planning, vol. 35, pp. 153178.
Kaufman, RA 2003, Strategic planning for success: aligning people, performance, and payoffs, San Francisco, Jossey-Bass/Pfeiffer.
In this scenario, the patient is a 33 years old Caucasian male with no significant prior medical or surgical history. He comes into the office with a complaint about a persistent rash on his skin. The patient claims that the symptoms first manifested approximately a week ago. When questioned about itchiness or pain, he admits that the area sometimes feels irritated, but does not significantly hurt. According to the patient, the region appears to be limited to a patch of reddened skin on his upper back. The manifestations of the increases in intensity do not seem to correlate to any pattern the man can observe. No other symptoms are present, and the patient claims to be in generally good condition, lead a healthy lifestyle, and have few to no allergies.
Objective
An examination of the problematic area reveals that there is a patch of skin of a considerably different color from the rest. The spot is reddened and roughly circular, approximately four centimeters in diameter. The area is slightly upraised and appears to have silvery discolorations scattered across its surface. The texture feels rough to the touch, and the patient can feel the contact without experiencing any particular discomfort. The spot does not feel significantly hotter than the surrounding area of the skin, and the patient’s temperature is normal. A further examination reveals no other places with similar characteristics, and the rest of the surface appears to be in good condition.
Assessment
Differential Diagnosis 1: Plaque Psoriasis
Pathophysiology
Plaque psoriasis is the most common variation of the skin condition, which is caused by immune system malfunctions. According to Menter (2016), this particular variety manifests itself as well-defined plaques of one to several centimeters in size, with thin silvery scales appearing on their surface. The condition is incurable and carries a high risk of comorbidities surfacing along with considerable negative impacts (Menter, 2016).
Pertinent Positive Findings
The description of the patient’s rash roughly matches the symptoms of the condition, particularly with regards to the specifics of the area. There are no other clinical manifestations, a trait often associated with psoriasis (Menter, 2016). Furthermore, itchiness, or pruritus, another trait of the condition, is also present.
Pertinent Negative Findings
The rash is not symmetrical, unlike what Menter (2016) asserts is the common tendency for psoriasis. Furthermore, the patient does not report any pain or malaise nor match the risk factors described by Menter (2016).
Rationale
While the patient does not match all of the specifics of psoriasis, Menter (2016) mentions that the condition can manifest in various ways that complicate diagnosis. The patient matches one of the two bimodal distribution groups of the illness, and its genetic nature means that risk factors do not necessarily have to be associated with the emergence of the condition (Menter, 2016). As such, a diagnosis of psoriasis appears to be appropriate, though testing should be conducted for other possibilities.
Differential Diagnosis 2: Atopic Dermatitis
Pathophysiology
Atopic dermatitis, also known as eczema, is a chronic relapsing illness that affects a significant portion of people worldwide. According to Sherazi et al. (2016), it is characterized by “pruritic, erythematous and scaly skin lesions” (p. 57). The condition is genetic, though various risk factors can complicate it or make it more likely (Sherazi et al., 2016).
Pertinent Positive Findings
The rash is similar to those caused by atopic dermatitis, is reddened, itchy, and scaly. The sudden quality of the lesion’s appearance also matches eczema’s tendency for sudden appearances, or flares (Sherazi et al., 2016).
Pertinent Negative Findings
Asthma is frequently associated with allergy (Sherazi et al., 2016), which the patient did not report. Furthermore, the condition usually surfaces during childhood and continues into adulthood (Sherazi et al., 2016), but the man claims he has no history of any skin conditions. Lastly, atopic dermatitis in adults tends to concentrate on the face, neck, and hands (Sherazi et al., 2016), and none of the locations match the patient’s symptoms.
Rationale
There is considerable circumstantial evidence that suggests that eczema should not be the cause of the patient’s skin irritation. However, much of it relies on unreliable information, as the patient may not remember past episodes or misreport his allergies due to factors such as lack of exposure. Ultimately, atopic dermatitis should not be considered the most likely diagnosis, but it deserves investigation.
Differential Diagnosis 3: Tinea Versicolor
Pathophysiology
Tinea versicolor is a condition caused by a variety of yeast that enters a state of uncontrolled growth and produces a pigmentation of the skin. According to Gantz & Allen (2016), the condition often manifests on the upper trunk and takes on a chronic nature. Like the other two conditions, it may be affected by a genetic predisposition that pushes a part of normal skin flora to proliferate (Gantz & Allen, 2016).
Pertinent Positive Findings
The location of the reddened patch, its color, and its scaly nature all conform to the symptoms of tinea versicolor as presented by Gantz & Allen (2016). Furthermore, the yeast responsible for the condition produces agents that reduce inflammation (Gantz & Allen, 2016), which is consistent with the evaluation of the patch.
Pertinent Negative Findings
Gantz & Allen (2016) mention that tinea versicolor tends to produce no pruritus and generally be asymptomatic. Furthermore, the symptoms do not include the silvery discolorations discovered during the examination.
Rationale
It is unlikely that tinea versicolor is responsible for the patient’s rash due to a mismatch in the symptoms. The basic facts are similar, but some of the particulars reported by the patient should not usually be presented during a case of the illness. Nevertheless, an investigation is warranted, mainly as this condition is easier to identify than others due to its microbial nature. According to Gantz & Allen (2016), skin scrapings can be analyzed for the presence of spores, conclusively confirming or denying the yeast infection hypothesis.
Plan
Skin Scraping Analysis
Rationale: An analysis of skin scrapings for yeast spores can confirm or rule out the tinea versicolor diagnosis. It is also possible to perform a biopsy to help evaluate whether eczema or psoriasis is the correct diagnosis (Salvador, Romero-Perez, & Encabo-Durán, 2017).
IgE Blood Test
Rationale: According to Salvador et al. (2017), the determination of the patient’s IgE serum levels is among the first actions that should be taken when suspecting atopic dermatitis. The test can help reinforce the diagnosis or debunk it based on the concentration discovered.
Skin Allergy Testing
Rationale: According to Gantz & Allen (2016), atopic dermatitis is associated with manifestations of allergy. Discovery of a reaction to an agent would reinforce the hypothesis that eczema is the correct diagnosis.
The Koo-Menter Psoriasis Instrument
Rationale: Psoriasis often has a considerable impact on the patient’s well-being due to its pronounced manifestations. According to van Voorhees, Feldman, Lebwohl, Mandelin, and Ritchlin (n.d.), the tool is effective for the assessment of various factors about the patient’s quality of life and the severity of the condition.
Tuberculosis Testing
Rationale: Many treatment options proposed for psoriasis by van Voorhees et al. (n.d.) propose that the physician should test for tuberculosis at baseline and annually. The use of biologics options can exacerbate the bacterial disease if used without proper consideration.
Menter, A. (2016). Psoriasis and psoriatic arthritis overview. The American Journal of Managed Care, 22(8), 216-224.
Salvador, J. F. S., Romero-Pérez, D., & Encabo-Durán, B. (2017). Atopic dermatitis in adults: a diagnostic challenge. Journal of Investigative Allergology and Clinical Immunology, 27(2), 78-88.
Sherazi, B. A., Hashmi, K., Afzal, F., Hassan, S. M., Hassan, S. K., & Iqbal, M. (2016). Assessment of causes, symptoms, prevention and clinical management of pediatric atopic dermatitis. Current Science Perspectives, 2(3), 57-60.
van Voorhees, A. S., Feldman, S. R., Lebwohl, M. G., Mandelin, A., & Ritchlin, C. (n.d.) The psoriasis and psoriatic arthritis pocket guide (5th ed.). Web.
Photographs in the past were regarded as a reliable way of keeping memories. Most people took photos for autobiographical purposes intended to serve as a memory and communication. For example, photographs were used as a reminder of how life was in the past. Photography has since moved on from a reserve of family memories into other fields. According to Maître (2017, p.1), this change began forty years ago when solid digital sensors replaced analog silver films. The introduction of solid digital sensors meant led to the development of point-and-shoot cameras that fits in a pocket. Then they were introduced into mobile phones and tablets, leading to the revolution of the photographic industry (Maître, 2017, p.1). Maître (2017, p.5) noted that compact cameras were the first digital cameras introduced in the 1980s.
Compact cameras comprised of a fixed lens, retractable focal length, and the viewing was done through a screen. These cameras could comfortably fit into a pocket. However, most cameras in modern society consist of internal and removable memory, visualization and modification screens, image stabilization elements, filters and lenses, and shutters, focus, and light measurement mechanisms (Maître, 2017, p.309). These advancements facilitated the integration of photography into the medical sector. This paper analyzes improvements of digital cameras in the healthcare industry, focusing on the field of dermatology.
Medical practitioners use photography for a variety of reasons while treating patients. In 1840, Alfred Donne photographed sections of bones, teeth, cells from body fluids, and cellular debris in what is the first recorded case of medical photography (Harting et al., 2015, p.401). Since then, advances in cameras have increased the application of photography in medical specialties, such as dermatology, radiology, pathology, and psychiatry.
The photographs are a great way to document patients’ history and are used to track the progression over time accurately. For instance, dermatologists use magnification and non-polarized light to view skin lesions, which helps in improving diagnostic capability (Harting et al., 2015, p.402; Michelangeli, 2019, p.7). High-quality images provided by digital photography are useful in the medical sector because doctors use them to track disease progression and educate patients.
Dermatology is a visual-based field because it involves the collection of photography and imaging for diagnosis and tracking the effectiveness of the medicine. According to Michelangeli (2019), doctors used to sketch or paint illustrations of skin diseases before the invention of photography. Therefore, the introduction of black and white photography in the mid-nineteenth century helped the doctors to capture images and hand color the areas with lesions after live observation. The introduction of digital and high-quality imaging systems further helped dermatologists in analyzing patients’ skin conditions.
Challenge
Several experiments have been conducted to evaluate the effectiveness of imaging and photography in dermatology. A study by Milam and Leger (2018) study included a total of 157 dermatologists, examined their habits and opinions. These researchers used SurveyMonkey questionnaires to gather answers from dermatologists in the United States. Of the total 153 participants who responded, 61.8% of the dermatologists indicated they use medical photography daily, whereas 21.7% reported they use imaging almost with every patient (Milam and Leger, 2018, p.5). The experts said varied opinions and habits on medical photography.
Milam and Leger (2018) noted the diverse use of photography in dermatology. 87.5% of the participants used photography to document biopsy sites, 60.0% in research and publications, 72.4% in teaching, 54.6% to liaise with dermatopathologists and care providers, and 82.9% to track disease progression. A total of 70 participants (46%) admitted that they used smartphones to take the images. 77.1% of those used smartphones, whereas only 42.9% admitted to using secure electronic medical record applications. Further, 75.7% of participants indicated they obtained consent for photographs from their participants to take the pictures.
Additionally, 74.5% reported that doctors received electronic or hard copies of photos from the patients, whereas only 47.4% confirmed using secure messaging systems. Milam and Leger (2018) study assessed privacy issues when collecting photographs and images from the patients. The privacy issues include consent, safety standards, and other liability concerns that occur when using patients’ photography.
Solutions
Necessary security measures should be put in place to safeguard pictures captured by dermatologists because they often contain personally identifiable information. A study conducted by Abbott et al. (2018) examined Australian dermatologists and dermatology trainees in their natural practices relating to clinical smartphone use. The study used an anonymous 24-question survey in the SurveyMonkey platform where the dermatologists were required to state their reasons for capture, transmission, and storage of clinical images. The survey also analyzed whether consent was obtained, awareness of current guidelines, and work policy as well as reliance on smartphones.
Results
In total, 105 dermatologists and dermatology trainees across Australia participated in the study. The results show that 97% of the respondents carried their smartphones with them at work. The majority of the participants indicated they sent or received images on their smartphones or emails regularly. Further, dermatologists stated they captured images of the patients mainly for obtaining advice from colleagues (60%), while 55% gathered images with the aim of monitoring patient progress (Abbott et al., 2018, p.102). Others captured images for education purposes (38%), communication with caregivers (34%), research (12%), and backup if dedicated cameras were to fail (8%). The main reasons for receiving or sending images were advice on diagnosis (90%), recommended treatment (85%), general counsel (32%), education (17%), and monitoring rural patients (5%). Most respondents used email (85%), 70% used text, and 7% used special applications for clinical photography (Abbott et al., 2018, p.103).
Figure 1: Frequency of taking photographs.Figure 2: Frequency of received images.
The study shows that consent was obtained when taking photographs, but not for documenting the images. Additionally, only 2% got written consent, while 30% sought verbal permission and recorded it as part of clinical documents. Further, 46% of the participants obtained verbal consent and did not document it in the patients’ records (Abbott et al., 2018, p.104). Also, research indicated 22% of the participants reported being aware of the workplace guidelines concerning the use of smartphones in clinical photography. Other respondents (34%) reported awareness of formal workplace procedures for using patients’ photos on smartphones.
Only a few people had read the guidelines on clinical photographs and the use of personal images, and 65% of the participants indicated the need for further education on taking, transmitting, and documenting clinical pictures on smartphones.
Evaluation
Evidence collected from the research studies shows that images collected by dermatologists are essential in improving service delivery. Abbott et al. (2018, p.105) noted that high-quality photos add value to clinical consultations, especially when the images accurately capture the color, texture, and depth of the skin lesions. However, there are considerable risks associated with the use of digital images in photography, especially when specialists fail to comply with the written technology-based guidelines. Therefore, dermatologists have moral and legal obligations to ensure photography captured supplements communication and services delivery without compromising the privacy of the patients. Specialists should also focus on obtaining written consent from the patients for specific purposes (Ashique et al., 2015, p.3). For instance, doctors should emphasize when the images are to be recorded and shared with other caregivers.
Without proper privacy guidelines, the adoption of digital technology in healthcare might create more problems than advantages they offer. Therefore, many organizations have focused on creating guidelines and policies for safeguarding information. For instance, the Health Insurance Portability and Accountability Act (HIPAA) was enacted to ensure the privacy and protection of medical records (Nettrour et al., 2019, p.2). As a result, any individually identifiable information is protected under HIPAA, including the images taken by dermatologists.
The communication mechanisms noted in the two studies do not meet the clinical guidelines and standards. The use of smartphones to text or email images exposes the data to potential attacks because they do not meet encryption standards. Nettrour et al. (2019, p.3) noted that even under the circumstances that the smartphones have encryption standards, images should not be texted, they can easily be intercepted. The authors recommended the use of electronic medical transmission systems because they are designed to store and share personally identifiable information securely. These systems also comply with HIPAA rules, such as performing data backup services and changing passwords regularly to ensure security. Dermatologists and medical professionals should seek written consent when they want to take, store, or share patients’ information.
Reference List
Abbott, L.M., Magnusson, R.S., Gibbs, E. and Smith, S.D. (2018) ‘Smartphone use in dermatology for clinical photography and consultation: current practice and the law’, Australasian Journal of Dermatology, 59(2), pp.101-107. Web.
Ashique, K.T., Kaliyadan, F. and Aurangabadkar, S.J. (2015) ‘Clinical photography in dermatology using smartphones: an overview’, Indian dermatology online journal, 6(3), p.158-163. Web.
Harting, M.T., DeWees, J.M., Vela, K.M. and Khirallah, R.T. (2015) ‘Medical photography: current technology, evolving issues and legal perspectives’, International journal of clinical practice, 69(4), pp.401-409. Web.
Maître, H. (2017) From photon to pixel: the digital camera handbook. John Wiley & Sons.
Michelangeli, F. (2019) ‘Imaging the unimaginable: medical imaging in the realm of photography’, Clinics in dermatology, 37(1), pp.38-46. Web.
Milam, E.C. and Leger, M.C. (2018) ‘Use of medical photography among dermatologists: a nationwide online survey study’, Journal of the European Academy of Dermatology and Venereology, 32(10), pp.1804-1809. Web.
Nettrour, J.F., Burch, M.B. and Bal, B.S. (2019) ‘Patients, pictures, and privacy: managing clinical photographs in the smartphone era’, Arthroplasty Today, 5(1), pp.57-60. Web.
The case study is related to a two month old infant suffering from infantile Atopic Dermatitis who is breastfed. Infantile Atopic Dermatitis is most common type of dermatitis which occurs before six months of age and continues through the childhood. More than 3 percent of infants are affected by it. It normally subsides by the time child reaches the magic twelve years mark. It is a skin disorder which is caused by hypersensitivity to allergen related reactions on the skin, causing characteristic inflammation, itching and scaling of the skin. It is frequently associated with the triad of other atopic (allergic) disorders like asthma and hayfever.
Breastfeeding does not contribute to the appearance of Atopic Dermatitis. Hence there is no need to stop breastfeeding. A study indicates that “exclusive breastfeeding does not influence the risk of Atopic Dermatitis during the first year of life, while presence of furred pets at home seems to be negatively associated with Atopic Dermatitis.” (Ludvigsson, para.1). A study further confirms that in case of infants who are at the risk of developing and Atopic Syndrome , there is possibility to prevent or delay these symptoms by exclusive breastfeeding for four months.
The important consideration here is the age at which breast milk is introduced rather than the duration of the breastfeeding. “Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of Atopy. But when breastfeeding beyond 12 weeks is combined with other foods, incidents of eczema rise irrespective of family history.”(Barr,para.12 ). The supplement of additional food, formula and milk suddenly affirms increase in the symptoms of Atopic Dermatitis. It would be advisable to delay formula and stay with breastfeeding and gradual introductions of soft foods for infants.
Mother should also practice caution in her intake of food which may produce adverse symptoms in the child like rashes or colic. Mother should avoid milk, eggs, wheat, fish and peanut.(Spagnola & Korb, para.34.). Infants from atopic families whose mother eliminated egg, milk and fish during lactation has less atopic dermatitis than those who had no dietary restrictions. (Metcalfe & Simon,pg.155,para1). Incase of baby food sometimes the trigger can be seen in foods like cereals, eggs, black olives and chocolate. Infant should receive solid food at four months. Caution should be observed with the reactions to various foods and their reaction to the child in terms of symptoms which reflect allergic response.
A significant linear relationship was found between number of solid foods introduced into the diet by four months of age and subsequent Atopic Dermatitis. (Metcalfe & Simon,pg.155,para1).Studies have further indicated that it is best to avoid exposing young infants to food allergens like peanuts, nuts, fish and shellfish for the first two to three years of life, in some cases where the risk of atopic reaction is high it helps to avoid cow’s milk for the first year and egg for the first two years. These factors would prevent to some degree occurrence of the Atopic Dermatitis.
If the infants symptoms worsens with certain exposure to environmental factors like pillows, blankets which indicate that there is allergic response to dust and dust mites then prompt measures should be taken to remove the environmental allergens like dust and dust mites to further reduce the triggering factors of the symptoms. One can also be encouraged to use air purifier with effective HEPA filter to control the level of floating allergens.
It would be necessary to get rid of any furry pets like cats and dogs as they have negative impact on the symptoms; it has been a proven fact.
The role of fish oils with its anti –inflammatory has been long studied in the prevention of allergic diseases. The study suggests that there is potential reduction in subsequent infant allergy after supplementation of polyunsaturated fatty acids in the form of fish oils.(Dunstan,para.1).
Probiotics have been known through many studies to have the potential to protect children form Aptoic Dermatitis for up to four years when given to pregnant women and babies around the time of childbirth. Probiotic bacteria has been suggested to have the power to reduce symptoms of Atopic Dermatitis syndromes in food allergic infants. (Viljanen.para.1). It should be taken by the mother during pregnancy as well as during breastfeeding and can also be given to the infant in regulated quantities to control the adverse effects of dermatitis induced by food allergies. This has really been effective in the case of occurrence of Atopic Dermatitis. This is found in lactobacillus bacteria, which is commonly found in food for fermentation. It is abundantly found in yogurt. Food supplements which are nutritionally enriched with these bacteria are called probiotics.
Probiotics have favorable effects on the gut and effects on developing immune system. (Mercola,para.6).
Once determined as high risk for Atopic diseases which consist of the triad of Atopic Dermatitis, asthma and hayfever all triggered by food allergens and environmental allergens the only remedy is to manage the symptoms and reduce the occurrence by sensible use of combination of fish oil, probiotics and immune boosting supplements. The symptoms can be controlled and managed but cannot be completely prevented. The baby needs to be monitored carefully as to what triggers the allergic reaction and must be protected from such exposure in the form of food or environmental allergen floating in the surroundings.
Metcalfe, Dean D. & Simon, Ronald A. Food Allergy: adverse reactions to food and food additives. Wiley. 2003.
Dunstan, Mori, Barden, Beilin, Taylor, Holt & Prescott. Fish oil supplementation in pregnancy modifies neonatal-specific immune responses and clinical outcomes in infants at high risk atopy: a randomized, controlled trial. J Allery Clin Immunol. 2003. Web.
Viljanen M, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, Tuure T, Kuitunen M. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial.Allergy. 2005. Web.
Kalliomäki, M.; Salminen, S.;.Arvilommi, H; Kero, P ; Koskinen, P.& Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial The Lancet, 2009. Volume 357, Issue 9262, Pages 1076-1079.
Mercola. Good Bacteria Prevents Eczema in Infants. 2003. Web.
Atopic dermatitis can be described as a kind of eczema or allergic disease resulting in a pruritic, non-contagious, inflammatory and chronically relapsing skin disease. If a baby has atopic dermatitis then he should be exclusively breastfed during infancy since this has been found to relatively reduce the development of atopic dermatitis. Those families with history of atopic dermatitis must breastfed the baby since he might have allergic reactions to cow milk or soy milk. Breastfeeding insures that no allergies can reach the baby protecting him from developing any allergic diseases. Those babies who are not artificially fed have to face lesser allergies then those who are fed special baby food formulas. (Meduri, 2007)
Infants with atopic dermatitis should be breastfed by their mothers till they are at least 6 months old since if it is continued after that then there may be a rise of atopic dermatitis as breastfeeding gets combined with other food habits. Infants with a family history of the disease need to be exclusively breastfed since through the breast milk they are able to not only meet their daily nutritional needs but are also protected from other food allergies. Breast milk also increases their immunity allowing them to fight away allergies. Even after solid food has been introduced mothers can continue breastfeeding but not for too long. (Diepgen, 2006)
Normally, a new mother does not need to avoid any specific foods in her diet whilst she is breastfeeding. However mothers having a family history of food allergies or with babies with atopic dermatitis should avoid only those food materials which may cause infectious diseases or allergies. Some of the foods materials a mother can avoid include shellfish, egg whites, food additives, soy or cow milk and nuts. If the mothers eat these foods then the babies may develop sensitivities towards them too. Mothers should consume a lot of healthy food including fruits and vegetables and try to avoid foods towards which her baby has an allergy. (Bergmann, 2008)
Babies who suffer from atopic dermatitis and other allergies should start to intake solid food only after they are 6 months old since a delay in the starting of solid food in these babies may delay and even reduce occurrences of allergic reactions. If possible mother’s can also delay the introduction of solid food to up to a year. The less solid food they consume the safer will they be from allergic reaction. Mother’s should never give their babies solid food to which they have allergic reactions. Foods which trigger allergic reactions in the baby should be completely avoided and only be given to the baby after 2 years. (Henriksen, 2008)
Environmental allergens, like dust mites, must always be removed from a baby’s immediate environment so that dust mite allergy can be prevented which might fasten the onset of the baby’s atopic dermatitis. Parents with a history of allergies or with kids having allergies need to be extra careful and utilize environmental control means so that dust mites can be removed which may trigger allergies in the baby. Even though dust mites may not immediately trigger any allergic reactions, if the child’s exposure to them remains uncontrolled, then they could cause serious problems. Not only dust mites but also allergen production needs to be controlled that are transported by the dust mites. (Zimmerman, 2005)
Most people are derailed quite easily by the misleading concept that the animal fur causes them to have allergic reactions. But these reactions are actually caused by the dander of the animal which is small scales or dead skin of the animal that flakes out when the skin regenerates itself. But if a baby is allergic to dander then it is better if the cat or dog is removed from its immediate environment since dander being small and light becomes airborne. Sometimes the urine and saliva of the animals can also carry allergens which the baby might come in contact with triggering immediate allergic reactions in him. (Bos, 2008)
Mothers and babies should both take fish oils. Fish oil supplements contain Omega-3 which has the potential of significantly lessening the symptoms of atopic dermatitis. This is because Omega-3 is capable of reducing the level of leukotriene B4 in the baby’s body which mainly promotes the disease. But the fish oils taken should always be of pharmaceutical grade and molecularly distilled so that there are no impurities in it. Pregnant women should also take fish oil supplements since it increases the level of DHA present in the body. During breastfeeding this DHA gets passed into the babies which helps him to fight atopic dermatitis. (Hanifin, 2007)
Probiotics contain helpful bacteria called Lactobacillus that reside in one’s digestive system and protect us from the development of disease causing organisms. Pregnant women as well as babies should consume probiotics till they are about 6 months since it can protect them from atopic dermatitis for at least 2 more years. (Ayelet, 2009) When mothers take probiotic supplements, the amount of anti-inflammatory molecules gets increased in their breast milk which when passed on the babies help them in fighting the allergies. Probiotic supplements should be consumed by pregnant women when they reach the 8th month of their pregnancy. Probiotics strengthen the immune system of the babies decreasing the development of atopic dermatitis in them by almost 30%. (Joo, 2009)
There are very limited numbers of medications that can be given to babies in order to reduce the risk of developing asthma in them. One of them which have shown some promise is Zyrtec or Cetirzine. It is an antihistamine and is used for treating hypersensitive reaction and allergies. This medication has been found to immensely reduce the progression of asthma in babies who also have problems of atopic dermatitis. It not only prevents allergic symptoms but also hives and skin rashes that are caused by the disease. Doctors can also try and give immunotherapy to the children since this too lessens the chance of development of asthma in children. By using this therapy the onset of asthma can be postponed for years, even when the baby has stopped taking the medicine shots. (Junichi, 2009)
References
Ayelet, S.A. (2009) The Relationship Between Sensory Hypersensitivity and Sleep Quality of Children with Atopic Dermatitis. Pediatric Dermatology 26(2), 143-149.
Bergmann, T. (2008). Atopic dermatitis in early infancy predicts allergic airway disease at 5 years. Clinical & Experimental Allergy 28(8),965-970.
Bos, J.D. (2008). Atopic dermatitis. Journal of the European Academy of Dermatology & Venereology 7(2), 101-114.
Diepgen, T.L. (2006). Model-based Clustering of Binary Longitudinal Atopic Dermatitis Disease Histories by Latent Class Mixture Models. Biometrical Journal 48(1), 105-116.
Hanifin, J.M. (2007). Characterization of cAMP-phosphodiesterase as a possible laboratory marker of atopic dermatitis. Drug Development Research 13(2-3), 123-136.
Henriksen, A. (2008). Atopic Dermatitis Among 2-Year Olds; High Prevalence, but Predominantly Mild Disease. Pediatric Dermatology 25(1) 13-18.
Junichi, H. (2009). Severity of disease, rather than xerosis, correlates with pruritus in patients with atopic dermatitis. International Journal of Dermatology 48(4) 374-378.
Joo, S.S. (2009). Therapeutic advantages of medicinal herbs fermented with ‘Lactobacillus plantarum’, in topical application and its activities on atopic dermatitis. Phytotherapy Research 23(7), 913-919.
Meduri, N.B. (2007). Phototherapy in the management of atopic dermatitis: a systematic review. Photoimmunol Photomed 23(4), 106–12.
Zimmerman, T. (2005). The Objective Severity Assessment of Atopic Dermatitis (OSAAD) score: validity, reliability and sensitivity in adult patients with atopic dermatitis. British Journal of Dermatology 153(4), 767-773.
In the 1990’s, professional organizations and government agencies made it possible to publish guidelines for clinical practices in regards to the prevention of PU Pressure Ulcers. However, the means of translating the guidelines on the bedside has continued to be a problem. Incontinence care has made it clear that it has become a significant task for clinicians. For patients who suffer from pressure ulcers and incontinence, to use RCT will be required using support surfaces and repositioning the patient in order to avoid exposure to urine or stool respectively and improve these conditions. In regards to the condition of pressure ulcers, proceedings and the policy state that every resident requires to have an assessment of the skin together with a treatment plan in line with maintaining the skin integrity and wounds in which management is needed. “Having the evidence that is current or at hand, repositioning of the patient, the use of support surfaces, watching for the nutritional status, and moisturizing sacral skin are all strategies that can be applicable in preventing pressure ulcers.” This new evidence occurred in a journal by studying a case of 39 RCT’s which had to be selected and categorized into three groups.
This article is a review that was conducted by the authors for the description of evidence which is at hand in regards to treatment and prevention. This is used to formulate the recommendations for research and clinical practice. Patients who have incontinence are fond to have issues to deal with dermatitis. This kind of challenges becomes a hindrance to practitioners and professionals. They find it difficult to maintain a healthy skin to victimized patients. “The data sources were retrieved from Cochrane, PubMed, PubMed, the, Embase, Allied Health Literature and Cumulative Index to Nursing, conference proceedings and reference lists in September 2008,” (Beeckman, Schoonhoven, Verhaeghe, Heyneman, & Defloor, 2009). There is a possibility of development which includes these terms. There is no requirement for a study design for a section in line with the characters which are explosive and with a scarce literature. The authors were able to place 36 publications which deal with 25 studies. The authors suggested the use of moisturizers for skin cleansing. This is an implementation of perineal skin. “Patients who are considered to have a high risk of incontinence that is associated with dermatitis are recommended to have a skin protectant.” (Beeckman et al., 2009). It is preferable to use ointments rather than water for the skin. “After every episode and stage of incontinence the care of the skin is usually suggested in particular when faeces are present.” (Beeckman et al., 2009). Thus, it is stated that incontinence can be avoided if the skin is protected and cleaned in time (Beeckman et al., 2009).
Discussion
The above article is a review on the quality improvements and interventions concerning pressure ulcers. This is a systematic review concerning nurse focus-intervention that is conducted in a hospital setting. This informs evidence that is based on implementations concerning the prevention programs of pressure ulcers. This article has little evidence concerning intervention and successful integration despite of the published guidelines that are available. “The two previous literature syntheses on PU prevention have included articles from multiple settings but have not focused specifically on QI (quality improvement).” (Lynn, et al., 2011, p. 245). The article is containing six electronic database searches for publications which were conducted between the years 1990 January to 2009 September (Lynn, Hempel, Munjas, Miles, & Rubenstein, 2011). The authors found that 39 studies were able to meet the criteria. A majority of them used a study guide known before and after through a single site. Some of the intervention strategies included the combination of quality improvement strategies and specific changes in pressure ulcers. By going through every study, the authors were able to come to a conclusion that there was a positive effect with those interventions. It will be possible to build a future research on the basis of implementation through increased emphasis on understanding the mechanisms. This proved that the outcome could be able to describe and achieve the appropriate conditions under specific intervention strategies which were likely to fail or succeed.
The article contains the methods of preventing pressure ulcers. It begins by defining a pressure ulcer which is a common problem for patient settings. The article involves the outcomes of adverse health and the costs of high treatments. The objective of the authors is to analyse and review the kinds of evidence that examine interventions for the prevention of pressure ulcers (Reddy, Rochon, & Gill, 2006). The sources for the research carried in the article are retrieved from Embase, Medline, and Cinahl. These were incepted from the Cochrane databases in the year 2006. They were searched, identified, made relevant and random through (RCTs) randomized controlled trials. There was a search for UMI, which is Proquest Digital Dissertations, and Cambridge Scientific Abstracts and includes ISI Web for Science. Almost all the researchers used the same terminology like pressure sore, pressure ulcer, bedsore, prophylactic, prevention, randomized, reduction, decubitus, and clinical trials. There was more review on references of articles that were identified. There was a selection of fifty-nine RCTs. The analysis of the cure was done on the particular subjects, thus, the authors were able to compile them into three categories, which include the ones that address impairments towards movement, skin health, or nutrition (Reddy, Rochon, & Gill, 2006). The quality of method and means which were used for RCTS were general suboptimal variables. “Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays.” (Reddy, Rochon, & Gill, 2006, p. 974). Through this, there are few evidences for the specific recommendation and turning regimens when it comes to patients who have impaired mobility. Supplements become a benefit to patients with poor nutritional and dietary supplements. “The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear.” (Reddy, Rochon, & Gill, 2006, p. 974). According to the results of the article (Reddy, Rochon, & Gill, 2006), repositioning the patient, usage of support surfaces, moisturizing sacral skin and optimizing nutritional status are the strategies that are appropriate for the prevention on pressure ulcers (Reddy, Rochon, & Gill, 2006). “Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations.” (Reddy, Rochon, & Gill, 2006, p. 974). In the article, there is a requirement for well-designed RCTs which follow a standard criterion for the report of non-pharmacological interventions. This created the formation of data provision towards cost effectiveness along with the interventions.
The following article written by Spark deals with the incontinence and its association with skin disease. The author begins defining the types of urinary that are involved in incontinence. They include functional, overflow, urge and stress. She also describes the skin types that may be involved in altering the life of an elderly person. The article majors on management and prevention of skin issues and functional incontinence, pressure ulcer and dermatitis (Sparks, 2011). Spark defines incontinence and provides the means of management and prevention. Incontinence is a frustrating, potentially disabling common condition that affects the elderly (Sparks, 2011). As aging is not the main reason for incontinence, urinary incontinence prevalence is the highest in terms of care facilities and reasons for institutionalization. All four urinary types of incontinence have their own symptoms. Stress incontinence results in loss of urine and an increase in abdominal pressure. Overflow incontinence is caused as a result of urinary retention in the function of the bladder. “Urge incontinence produces inability to delay voiding after sensation of fullness.” (Sparks, 2011, p. 22). Finally, functional incontinence is compared to cognitive function or impaired physical, environmental barriers or unwillingness. The author explains that there are various types of interventions that may assist in the prevention of urinary incontinence. These interventions include faecal impaction, prevention of urinary tract infection, heart failure and diabetes mellitus, reduction of diuretic fluids, correction of hypercalemia, avoidance of chemical or physical restraints and medication management that may cause urinary incontinence.
The above mentioned authors of the article were involved in a multinational group which should have had to evaluate and review a research that examined IAD incontinence associated with dermatitis. The study implements the knowledge into the best practical recommendation on the existing evidence. In this article, the authors reveal information which consists of evidences that may provide insight into pathophysiology, etiology and epidemiology of IAD. In the article, they were able to identify a research which supports the use of skin care that is defined based on principles which are application of skin protectants, miniaturization, and gentle perineal cleansing. The article also indicates that clinical experience supports applications with faecal incontinence, a high use of anti-inflammatory products in special cases, urinary aggressive containment, and crème having cutaneous candidiasis, and ointment. Due to the study conducted, the researchers were able to come up with a conclusion that research would remain limited and there was an urgent requirement of additional studies that would enhance the understanding of IAD (Gray, Beeckman, Bliss, Fader, Logan, Junkin, Selekof, Doughty, D & Kurz, 2012). This would create an establishment of evidence which was based on protocol for its treatment and prevention.
This article contains a definition of perineal skin breakdown, problems that are encountered in the community concerning IAD, a case study of Mrs Smith, as well as treatment and prevention of IAD. The authors start with defining what IAD is stating that it is referred to as a clinical manifestation of moisture that is associated with skin damage. They continue to explain that it is a known problem which is common to patients who are dwelling in the community. Nurses in the society have had a very significant challenge with the management of IAD, urinary incontinence, and patients with faecal (Beeckman, Woodward, & Gray, 2012). This calls for a need to empower nurses to be able to handle such conditions. The purpose for writing the article is focused on the provision of brief updates concerning the treatment and prevention of IAD. It also examines the difference between pressure ulcers and IAD, as well as pathophysiology of IAD (Beeckman, Woodward, & Gray, 2012).
Conclusion
The elderly people are tend to get infected with IAD and IU. These conditions can be treated due to some interventions that are effective to the patient. The kind of intervention that requires to be implemented is repositioning the patient and moisturizing the skin using cleansers. The case study of Mrs Smith and the damage of her skin are also disappointing because it turns out that the community nurses are unable to handle cases of pressure ulcers and incontinence. There is a need for improvement of level of the courses the nurses take. The health practitioners should be able to handle such conditions considering the frequency they affect the elderly. The gap in this research reveals more evidences that ought to be applied to support the policy and procedures. Are there other possible cases where someone who is young has experienced symptoms of pressure ulcers and incontinence? In relation to the PICO question, the two conditions of incontinence and pressure ulcers are treatable and can be detected soon enough to avoid permanent damage. The findings and the evidences that are retrieved from the nursing profession are based on facts and real life research. Nurses are the people who spend a lot of time with the patients, so they are able to monitor any changes that may occur. It is also easy for them to follow up on any proceedings because of their capability to translate and interpret the guidelines that are on the bedside. The nursing field requires a lot of accuracy in writing. Perfection on writing the correct format ensures that no mistakes are done and guarantees that one understands the importance of writing. This is not only significant in formatting but also reporting. This is applicable in chart and reports, which have to be done in the correct way. The interactions that are made with the patients and doctors have to be done fairly. Professional writing is important in nursing because as a situation occurs, one has to be able to manage the recorded information.
References
Beeckman, D., Schoonhoven, L., Verhaeghe, S., Heyneman, A., & Defloor, T. (2009). Prevention and Treatment of Incontinence-Associated Dermatitis: Literature Review. Journal of Advanced Nursing 65(6), 1141–1154.
Beeckman, D., Woodward, S., & Gray, M. (2012). Incontinence-Associated Dermatitis: Step-by-step Prevention and Treatment. British Journal of Community Nursing 16(8), 382-389.
Gray, M., Beeckman, D., Bliss, D.Z., Fader, M., Logan, S., Junkin, J., Selekof, J., Doughty, D., & Kurz, P. (2012). Incontinence-Associated Dermatitis: A Comprehensive Review and Update. The Wound, Ostomy and Continence Nurses Society 39(1), 61-74.
Lynn, M., Hempel, S., Munjas, B.A., Miles, J., & Rubenstein, L.V. (2011). Preventing Pressure Ulcers in Hospitals: A Systematic Review of Nurse-Focused Quality Improvement Interventions. The Joint Commission Journal on Quality and Patient Safety 37(6), 245-252.
Reddy, M., Rochon, P. A., & Gill, S.S. (2006). Preventing Pressure Ulcers: A Systematic Review. Clinician’s Corner 296(8), 974-984.
Sparks, M. (2011). Incontinence and Associated Skin Care. Long Term Living Magazine, 22-25.
This research report examines and discusses a case study scenario of a patient suffering from loss of elasticity and inflamed skin, atopic dermatitis and post-pregnancy melasma. Followed by referral recommendation and composition of the skin pre and post-treatment. Aesthetic procedures that meet the patient skin concerns. Additionally, discussing the pre and post care including additional treatment product recommendations within the Aesthetics scope of practice. With the report on how recommended modalities and treatment plans meet the patient’s objective and a brief conclusion.
The treatment plan to support the practitioner
Justification of the referral
As it is not in the dermal clinician’s scope of practice to treat collagen injection and atopic dermatitis, Ying Yue is referred to a dermatologist to further support her with her lip sensitivity and concern. Besides the lip sensitivity patient’s condition of atopic dermatitis is also referred to a dermatologist to further assess the condition and may recommend topical solutions and medication which aestheticians are not specialized to prescribe any serious medication to patients. A dermatologist specializes in that specific area and may further assist with the condition (ASDC, 2018). Moreover, the patient must be made aware of specific triggers that can deteriorate the condition. Such triggers include stress, anxiety and certain kinds of food allergies. For a better understanding of her condition, the patient must find out about its severity as well. The issue of lip sensitivity requires a further assessment as well. It is important to tailor the treatment to the patient’s needs.
Physiology of the skin pre-and post-procedure
There are many causes of people requiring aesthetic procedures, but most of them are related to its issues prior to the treatment. For example, while aging may be caused by genetics and age, external factors such as smoking, poor diet and pollution also contribute to the problem (Halliday, 2020). The negative effects of air pollution may not only damage the skin’s functions and barrier. They may also remove its prior elasticity, thus making the patient look older than they may be. The sun is notorious for contributing to the issue of premature aging as well, thus making the use of SPF products far more crucial. At times, pregnancy can lead to certain consequences for the patient’s skin, similar to the ones depicted in the case study. One’s way of life may cause negative consequences as well; for example, an unhealthy diet with fatty foods may lead to acne.
Laser treatment and hyaluronic acid are safe treatment methods for one’s skin care. However, considering that the use of photosensitive therapy is not as thoroughly researched as botulotoxin injections, there may be some side effects after the procedure. The patient may experience possible complications after the treatment. Fortunately, these complications can easily be treated with certain medications. Issues similar to slight pain or burning may happen after the treatment; however, sometimes, they may be more severe. If the patient follows all of the necessary recommendations to preserve the achieved results, there are higher chances of their condition improving in the near future.
Pre- and post-skin care regimes for the aesthetic procedure
Skin care regimes are very important when it comes to clients’ skin care. They may either help maintain the results or have the patient lose progress. The primary focus should be to help improve barrier function and skin hydration. Therefore, some basic homecare regimes are recommended to Ying Yue. The following ingredients such as hyaluronic acid, moisturizer, and antioxidant reach products containing Vitamin C ingredients and niacinamide assist in barrier function, improves skin hydration and prevents certain skin disorders (Urdiales-Galvez et al., 2019); (ASDC, 2021).
When it comes to patient skin care, pre-and-post treatment care is very important. This will benefit not only the patient with the treatment outcome as well as the aesthetic practitioner’s treatment improvements. However, patients sometimes may not adhere to the pre-and-post-care advice and it is the aestheticians’ responsibility to properly educate the patient during the consultation process. Prior to the necessary care, patients should focus on exfoliation, cleansing and strengthening the skin. This will make the skin healthier and ensure recovery after the procedure. After the care, patients should be thoroughly educated that maintenance with the treatments may require measures in order to prevent signs of aging and maintain healthy skin. Similar to ageing, skin protection is just as crucial for maintaining a healthy skin. For example, when exposing skin to the UVA sun, protection must be worn to avoid sunburn and further cause of ageing or skin cancer. Stress and lack of sleep may be severe triggers for further aging and for conditions similar to atopic dermatitis.
Modalities/treatments within the scope of a dermal therapist
Radiofrequency
Radiofrequency is a non-invasive procedure that uses soundwaves vibrations to stimulate skin cells. It helps further stimulate the reception of collagen and neocollagenesis. Unlike other more common treatments, radiofrequency has fewer side effects and is safer in general. There are no known contraindications to RF at the moment. This treatment method can find certain layers of tissues, causing collagen contraction and tightening the skin. Monopolar RF may cause burning and pain due to the deep penetration depth. More severe reactions are less likely; however, it is advisable to cover the patient’s eyes and set a moderate radiofrequency level without intermediate overlapping (Halliday, 2020); (Lyu and Liu, 2021).
IPL
IPL is an Intensive Pulsed Light that uses different wavelengths and is not monochromatic in essence. Due to that, it is not exactly a laser, but this treatment method happens to replace the pulsed dye one in a number of circumstances. IPL uses noncoherent, polychromatic and non-collimated light that has different pulse durations. It is not highly recommended to use this laser to cure certain vascular lesions due to possible complications. Intensive Pulsed Light may sometimes lead to some complications, despite being a rather safe treatment method. Fortunately, this can be prevented by properly choosing the right patient, technique and filler (Urdiales-Galvez, et al, 2019); (Augustyniak, Rotsztejn, 2017).
Microoneedling
Microneedling has become widespread in the past few years. It is a procedure that uses needles to puncture the skin. This helps the skin stimulate the production of collagen and repair mechanisms. Dr.Alster believes that this method may help people who struggle with large pores, wrinkles, stretch marks and scars. Microneedling involves sterile needles that puncture deep enough to trigger bleeding. It is crucial to mention that since similar at home items have duller needles and do not puncture the skin severely enough, the effect is temporary. People with acne and other kinds of inflammations are at a risk of infection, thus, they are not recommended to use this procedure. Microneedling may sometimes lead to slight skin redness that can sometimes stay for a week. There is not enough research to show if this method can be more effective if paired with other ways of treatment (AAD, 2018).
How the procedures and treatment plans meet the patient’s objectives
When it comes to a treatment plan, a thorough consultation procedure is very important. In order to help create a proper treatment plan. It is also crucial to recommend a suitable treatment plan which appropriates to the patient’s needs and concerns. Since the above modalities are used to treat various skin concerns such as acne, pigmentation, especially skin rejuvenation, therefore, they are to assist Ying Yue in improving collagen production, which further supports in reduction of fine lines and wrinkles and enhances the appearance of her skin. Antioxidants akin to vitamin C may also restore the patient’s skin barrier (Pigatto and Diani, 2018). They are known for protecting the skin’s external environment and preventing specific skin diseases. Moreover, antioxidants can help Ying Yue with the aging process, since they make skin cells age more slowly. As mentioned earlier, her skin has been negatively affected by the pollution. Thus, it is important to restore the barriers that were damaged by it. Moisturizing the patient’s skin will not only restore the barriers but may amend her atopic dermatitis as well. However, since Ying Yue’s skin cannot function properly, advanced kinds of treatment are inadvisable since may irritate the skin, thus, deteriorating the patient’s severe condition. The patient’s melasma may have been caused by sun exposure. This condition is common among reproductive-aged women like her. Tyrosinase inhibitors may lighten the patient’s skin; chemical peels like lactic or salicylic may help with the woman’s condition as well. These aforementioned treatments may help the patient overcome these conditions.
Conclusion
Designing a treatment plan is complex and requires knowledge and understanding of the patient’s main concern and, more importantly, recommending suitable treatment advice that could help patients improve their skin concerns. Also, when analyzing the case study, it was complex to recommend a proper aesthetic procedure, especially for patients with several skin concerns. Therefore, require a combination of treatment to improve the condition. The patient is referred to seek further advice from a dermatologist.
References
The Role of the Environment and Exposome in Atopic Dermatitis – PMC (nih.gov).
Part Two: Atopic Dermatitis Management (dermalclinicians.com.au).
Lyu, J.; Liu, S.* (2021) Radiofrequency in Facial Rejuvenation, International Journal of Dermatology and Venereology: doi: 10.1097/JD9.0000000000000193
Sarkar, R., Arsiwala, S., Dubey, N., …… (2017). Chemical Peels in Melasma: A Review with Consensus Recommendations by India…: EBSCOhost.
Vashi, N.A, Wirya, S.A., Inyang, M., Kundu, R.V. (2017). Facial hyperpigmentation in skin of colour: Special consideration and treatment. American Journal of Clinical Dermatology; Auckland, Vol. 18, no. 2, pp. 215-230. Web.
Real-time interactive consultations can improve patient outcomes. Such consultations often lead to positive changes in diagnosis and patient management. Telemedicine is an excellent tool in treating dermatological patients, as skin diseases can be easily studied through digital photo or video images (Trettel et al., 2018). Telemedicine consultations generally improve the quality of medical care. They allow one to provide care for those who do not have the opportunity to quickly and conveniently get an appointment with a dermatologist. Telemedicine is in increasing demand in geographically remote areas and other populated areas with insufficient medical care. Telemedicine in dermatology involves saving image files and sending them to a dermatologist for review (“store-and-forward” operation) at any time (Bastola et al., 2021). Another method of telemedicine is interactive video conferencing, which allows for real-time communication between patients, referring doctors, and consulting specialists. The advantage of such interactive conferences is getting acquainted with the patient’s medical history quickly. The specialist can also immediately capture and save additional digital images when more detailed clinical information is needed.
In 2019, the Dubai Health Authority (DHA) launched a new “Doctor for Every Citizen” initiative (The Official Portal of the UAE Government, 2019). Now every UAE citizen will have free round-the-clock access to doctors’ consultations and will receive it without leaving home, office, and any other location. DHA CEO Humaid Al Qutami presented the initiative at a management meeting and said the project aims to fulfill the terms of a 50-year directive issued by His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai. Thanks to the initiative, the Dubai healthcare system will increase its ranking concerning the best international systems in the world. Fifty specialists from public and private hospitals were trained to provide online consultations at the start of the launch of the telemedicine platform. This is an essential step in the era of integrated healthcare delivery systems using intelligent digital technologies such as electronic health records and electronic prescriptions and, of course, telemedicine. Currently, the telemedicine consulting program is available to any UAE citizen. The full version of the electronic medical record of patients registered with DHA will be made available to general practitioners (GPs) and family doctors during the consultation.
The way the program works is similar to the Tattvan E-Clinic business model. At the initial stage of Doctor for Every Citizen’s work, patients will receive advice on diabetes, allergies, hypertension, and dermatological problems, as these are among the most common health problems. In the future, specialized services will be added to the list. To book a consultation, the patient can either download the DHA app or call the DHA toll-free number 800 342. The doctor and patient will also be able to communicate via video call. The patient is assigned a specialist who gains access to the electronic medical record. At the first admission, the patient receives a preliminary diagnosis, and in the future, they are supervised by a specialized specialist who will issue a prescription. If necessary, medications will be delivered to their home. If a patient requires a diagnostic examination or complex tests, he is sent to the hospital, registered online for testing.
In fact, in order for Tattvan E-Clinic to enter the UAE market, the organization needs to focus on its target audience, which is non-UAE citizens residing in the state’s territory. Traditional is the strategy of state support, that is, providing medical service providers with the necessary information about the conjuncture of foreign markets, advertising the national market for medical services abroad, and concluding contracts between the government of the country and foreign companies for the development of the national market (for example, in the UAE, Saudi Arabia, South Korea) (Zajicek,& Meyers, 2018). Thus, the competitiveness of medical service providers in the world market is determined by the level of development of the national market for medical services and the share of private funds in health care financing, and the availability of effective instruments of state support for national medical service providers. These tools are being successfully applied in developing countries to increase the involvement of national providers in the global healthcare market, thereby creating a healthy competitive environment for international healthcare companies from developed countries. The entry of Tattvan E-Clinic into the UAE market implies creating a reasonable offer for low-income UAE residents who do not have access to public health care. The SWOT analysis shows that the most appropriate strategy for entering the UAE market, taking into account the existing supply and competition, is the very precise segmentation of the target audience while maintaining affordability as much as possible. The analysis revealed that the strengths of dermatological telemedicine in Dubai are the availability to every citizen and a high degree of technological development. At the same time, the major weakness is the inaccessibility of health care for non-citizens of the country. In connection with the increase in the number of immigrants in the UAE, a situation began to arise when doctors simply could not serve everyone, there was not enough medicine, and local residents could not get to the hospital because all the beds were occupied. It was decided that only citizens can use free medical care, and migrants can visit hospitals only by paying for an appointment or buying medical insurance in advance, which covers the costs (Al-Samarraie et al., 2020). A doctor’s appointment is quite expensive without insurance: for example, a regular consultation with a doctor will cost 40-50 dirhams. To call a specialist at home, one will need at least 70 dirhams. The simplest operation costs at least 10 thousand dirhams. However, here telemedicine opens up new possibilities: dermatology, being a specialization in which telemedicine technologies are justified and the most developed, is an area subject to the most rapid reduction in the cost of admission.
In addition, opportunities are the involvement in the cooperation between the medical corporation Partners Harvard Medical International and the government of the Emirate of Dubai, within the framework of which Dubai Healthcare City was founded (Anttiroiko, 2018). Currently, Dubai Healthcare City is the largest international medical hub in the Middle East region, driving the development of medical tourism. Dermatologists in Dubai engage with the knowledge and experience of the global medical community through professional involvement in the innovative foreign telemedicine market and the subsequent expansion of the company in the Far East (Alnakhi, 2021).
On the other hand, threats are primarily associated with legal difficulties. For example, dermatologists accredited in other countries cannot consult patients in the UAE. This can lead to the need for specialists to relocate and re-accreditation to the UAE, potentially leading to an increase in the overall cost of the clinic’s services. Besides, there are issues related to data storage and its ownership (Moonesar, 2019). Most probably, it will be the UAE that owns the data of patients disregarding their nationality.
References
Al-Samarraie, H., Ghazal, S., Alzahrani, A. I., & Moody, L. (2020). Telemedicine in middle eastern countries: progress, barriers, and policy recommendations. International journal of medical informatics, 141, 104232.
Alnakhi, W. K. (2021). Medical Travel and Public Health: Definitions, Frameworks, and Future Research. In Growth of the Medical Tourism Industry and Its Impact on Society: Emerging Research and Opportunities (pp. 74-94). IGI Global.
Anttiroiko, A. V. (2018). Wellness City Strategies in Local-Global Dialectic. In Wellness City (pp. 99-137). Palgrave Pivot, Cham.
Bastola, M., Locatis, C., & Fontelo, P. (2021). Diagnostic reliability of in-person versus remote dermatology: a meta-analysis. Telemedicine and e-Health, 27(3), 247-250.
Moonesar, I. A. (2019). Electronic Health Record Management: Dubai Health Authority’s Project ‘SALAMA.’ In Future Governments. Emerald Publishing Limited.
The Official Portal of the UAE Government. (2019). Telemedicine. The United Arab Emirates’ Government Portal. Web.
Trettel, A., Eissing, L., & Augustin, M. (2018). Telemedicine in dermatology: findings and experiences worldwide–a systematic literature review. Journal of the European Academy of Dermatology and Venereology, 32(2), 215-224.
Zajicek, H., & Meyers, A. (2018). Digital health entrepreneurship. In Digital health (pp. 271-287). Springer, Cham.
In the case study, a subjective portion of the note provides a clear picture of the patient’s habitus, complaints, and anamnesis. However, it needs particularization about the last time the patient had unprotected sexual intercourse as it can help indicate the incubation period. The presence of similar skin defects at the patient’s recent sexual partners and the previous existence of similar skin defects on the patient’s skin and mucosae can define the duration of the disease and the episode number. The appearance of spread rash all over the patient’s body can indicate of duration and period of the disease. The intake of any medications, including antibiotics, for the last one month, can affect further diagnostics, tactics, and treatment plans; indicate fixed drug eruption. The patient’s anamnesis lacks gynecological questioning on menstruation details, number of pregnancies and abortions, and pregnancy prophylaxis. It is also significant to specify the patient’s travel history for differential diagnosis of chancroid, lymphogranuloma venereum (LGV), and granuloma inguinale (Afzal, 2020).
The objective notes should primarily include physical examination such as palpation of the lymph nodes because one of the significant signs of primary syphilis is regional lymphadenitis, and secondary syphilis manifests with systemic lymphadenopathy. The assessment of the skin and mucosae in the rectal area, periorbital space, mouth mucosa, examination per vaginam is also needed. Multiple chancres can occur if numerous sexual contacts with the contaminated partner during the recipient’s incubation period happened or if numerous locations of bacteria invasion during one sexual act took place. An attentive examination of oral mucosa can indicate Behçet disease if the ulcers in the mouth are painful and correlate with uveitis, skin lesions, muscular and joint pain, gastrointestinal symptoms.
The diagnostic tests should include tests for syphilis (VDRL together with darkfield microscopy or direct fluorescent antibody test), polymerase chain reaction (PCR) for HSV, DNA amplification tests for chancroid, and LGV (Roett, 2020). The last instanton in diagnostic search, if all previous tests are negative, should be a histological examination of a tissue biopsy searching for Donovan bodies specific for granuloma inguinale (Kang et al., 2019).
The assessment is mostly supported by objective data as tests results are the most trustworthy. A contingent of patients with STDs has peculiarities of providing false data to the doctor, and their anamnesis information should be critically evaluated. Syphilis is an appropriate diagnosis for this case, and test results can be used to confirm or reject it. It is significant to every medical worker to be concerned about syphilis; even though the disease is not spread overall, the impact on all systems and organs of the human body has dramatic consequences. Syphilis is one of the ancient diseases; still, current medicine lacks the alertness on its diagnosing as it may, for instance, mimic other oral manifestations (Dybeck Udd & Lund, 2016). As a differential diagnosis, HSV infection can be reviewed, and the differential search for it will be grouped vesicles on an erythematous background, leaving shallow ulcers (Vestergaard, 2018) afterward. Chancroid, or soft chancre, is caused by Haemophilus ducreyi, is spread in Africa and Asia, has an incubation period from 24 hours up to 15 days, and represents a painful ulcer located unilaterally (Agharbi, 2019).
Lymphogranuloma venereum is caused by L-serovars of chlamydia trachomatis and is spread in endemic regions of Africa, South-Eastern Asia, South, and Central America and manifests with inguinal and anorectal syndromes (Kand et al., 2019). Granuloma inguinale is caused by Klebsiella granulomatis and is endemical for South Africa, India, South China, and Brasilia, and ulcers tend to slowly enlarge and have raised rolled margins (Afzal, 2020). Behçet disease can also be used for differential diagnosis though it is a rare multisystemic disorder engaging several organs into the pathogenic process. The clinical picture is bright with painful and deep oral and genital ulcers, uveitis, and non-obligatory gastrointestinal, muscle, and joint involvement (Davatchi et al., 2017). Syphilis lesions are rarely painful, have a variety of skin elements, especially in the second period, and primary ulcer has a typic induration in the basement (Kang et al., 2019).
References
Afzal, O. (2020). Genital ulcer disease. Obstetrics and Gynecology, 31, 253–257. Web.
Agharbi, F-Z. (2019). Chancroid. Pan African Medical Journal, 33, 1-5. Web.
Davatchi, F., Chams-Davatchi, C., Shams, H., Shahram, F., Nadji, A., Akhlaghi, M., Faezi, T., Ghodsi, Z., Abdollahi, B. S., Ashofteh, F., Mohtasham, N., Kavosi, H., & Masoumi, M. (2017). Behcet’s disease: Epidemiology, clinical manifestations, and diagnosis. Expert Review of Clinical Immunology, 13(1), 57-65. Web.
Kang, S., Amagai, M., Bruckner, A. L., Enk, A. H., Margolis, D. J., McMichael, A. J., & Orringer, J. S. (2019). Fitzpatrick’s dermatology, 9e. McGraw-Hill Education.
Roett, M. A. (2020). Genital ulcers: Differential diagnosis and management. American Family Physician, 101(6), 355-361.
Vestergaard, T. (2018). Genital herpes. Ugeskr Laeger, 180(20), V01180024.
Pressure ulcers are a common occurrence in the medical field, affecting patients that are immobile due to illness or injury, or the elderly that typically have less mobility. A pressure ulcer can be defined as localized damage to the skin and soft tissue underneath as a result of intense or prolonged pressure, or pressure combined with shear. The prevalence of pressure ulcers has remained relatively consistent in the United States, affecting nearly 3 million adults. However, healthcare costs have been increasing and pressure ulcers, if left untreated, can cause severe health issues such as localized or general infection, or necrosis. Approximately 60,000 people die from pressure ulcer adverse outcomes each year (Mervis and Phillips, 2019).
Pressure ulcers can occur both during hospital stay or after discharge during homecare. Many housebound adults who may be immobile due to age, injury, post-surgery recovery, or other illnesses are at-risk to develop pressure ulcers. Unlike in hospitals, there is no regular nurse presence to aid in changing of positioning, dressings, or identifying ulcers early on. Therefore, literature indicates thatan effective solution for adults in community settings is the use of pressure reducing surfaces. At the most primitive level, there are recommendations to use pillow, cushions, or mattress pads to reduce the pressure and support the area (MedlinePlus, 2020).
More complex interventions would be the use of pressure reducing support surfaces. This is identified as durable medical equipment (DME) and used to care for pressure sores and ulcers. Pressure reducing support surfaces can be split into three groups dependent on complexity. Group 1 are surfaces meant to replace the mattress or serve as an overlay include specialized mattresses, pressure pads, and overlays from foam, water, or gel. Group 2 is similar but includes more complex devices such air flotation beds and powered pressure reducing mattresses. Finally, Group 3 are complete bed systems including air-fluidized beds which use circulation of filtered air (United Healthcare, 2021). Pressure reducing support surfaces are meant to prevent pressure ulcers or contribute to the healing of existing sores. This is achieved by limiting tissue interface pressure to the best possible extent, most often by improving circulation and conforming to the contours of the body and spreading pressure over wider areas of the body (Rae, Isbel and Upton, 2018). There is a general consensus among literature that active and reactive support surfaces are effective in prevention and treatment of pressure ulcers.
Reference List
Medline Plus (2020) How to care for pressure sores. Web.
Mervis, J.S. and Phillips, T.J. (2019) ‘Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation,’ Journal of the American Academy of Dermatology, 81(4), pp. 881–890.
Rae, K.E., Isbel, S. & Upton, D. (2018) ‘Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review,” Journal of Wound Care, 27(8).
United Healthcare (2020) Pressure reducing support surfaces.