Category: Health & Medicine 13691

Introduction

This article was written by Rodgers, Bradley and Michael. They were trying to investigate whether there was a need for several medical checks in terms of X-rays during the examination of accident victims. They had suggested that only one test was enough in order to avoid the hustles involved and to avoid over-exposure of radiation to the patients (Rogers, Bradley, & Michael, 1995).

Summary

The authors of this article believed that the number of radiographic examinations was unnecessarily many. They argued that they should be reduced to clinical needs. Whenever the doctors in the Accident and Emergency got patients from accidents, they were always involved in performing numerous X-ray examinations. These were deemed unnecessary since fractures could be detected using a single procedure as proposed by the authors. This is what is referred to as occipitomental radiography.

The authors conducted their research at Birmingham Accident Hospital. They also reviewed radiographs that were collected earlier. Of all the patients involved in the experiment, 60 of their radiographs were reviewed. The results suggested that out of all the assessors involved in diagnosing the presence or absence of fractures, the maxillofacial middle-grade practitioners were among the most correct. Others include the radiographers and the consultant trauma radiologists.

It was suggested that the radiographers could be used to assist casualty officers in the diagnosis. However, the study suggested that due to the high numbers of false-positive diagnoses, it would need the intervention of another professional. The clinician had to confirm the assessment provided initially. Therefore, the study suggested that by using only one occipitomental view and a few other views, the fractures could be detected correctly.

Strong and weak points

The strong point of the article is the authors are able to argue their position strongly using relevant research findings. One weakness identified is that the authors did not determine the optimum projection that would show C7/T1 in adults with the same condition.

Conclusion

This article clearly provides a solution to the risk of exposure of radiation to the patients using one procedure in the determination of the presence or absence of fractures. This also helps reduce the cost of diagnosis due to the use of numerous X-ray examinations.

References

Rogers, S., Bradley, S., & Michael, S. (1995). The diagnostic yield of only one occipito-mental radiograph in case of suspected midfacial trauma  or is one enough? British Journal of Oral and Maxillofacial Surgery, 33, 90-92.

An increasing variety of toothbrush types is available in the market today. Aside from traditional manual tools implementing different bristle design solutions, popular options for consumers include oscillating-rotating (OR) electric toothbrushes and tools that generate ultrasound to improve plaque removal. Dental care recommendations related to toothbrush selection may need to be clarified to reflect the most recent research regarding the links between toothbrush type and specific conditions, such as gingivitis.

Clinical Scenario

From my professional practice, adult patients with gingivitis, which is an extremely common form of gum disease, report concerns when it comes to choosing toothbrushes. Particularly, based on my interactions with this healthcare consumer demographic, these patients are interested in learning about the best toothbrush type to prevent gingivitis progression and remove plaque effectively. Despite adhering to all recommendations, some patients continue to give preference to manual brushes just due to fearing that the use of newer electric toothbrush models might result in increased sensitivity and harm their enamel. In some other cases, patients with this condition might see purchasing electric toothbrushes as an overrated investment, which affects their choices. Toothpaste selection and the frequency of brushing teeth can also play a role in gingivitis reduction and prevention (Ccahuana-Vasquez et al., 2019). Nevertheless, it is important to find out whether OR electric toothbrushes are more beneficial for those with gingivitis compared to manual toothbrushes in terms of dental health outcomes. Answering this clinical question would support the improvement of patient education practices and help patients with the first stage of gum disease to make informed choices.

PICOT Question Based on the Scenario

Taking the aforementioned problem into account, it is possible to formulate a PICOT question of the type that deals with selecting the most effective intervention in a specific population. The PICOT statement: in adults with gingivitis (P), how does the use of OR electric toothbrushes (I) compared to manual toothbrushes (C) affect gingival health status and plaque status (O) within a four-week time frame? The answer is anticipated to support patient counseling by providing those with gingivitis with assistance when it comes to selecting the best toothbrush.

PICOT Question and Approaches to Research

The posed PICOT question could be answered using quantitative research designs, such as a quantitative systematic review of literature on the topic, especially randomized controlled trials. The main reason for giving preference to quantitative approaches is the nature of the anticipated outcomes. They are measurable and can be converted into numerical values and compared by using one and the same dental health assessment procedure in all subjects. Moreover, the selected intended outcomes do not deal with subjective experiences and perceptions that would require in-depth qualitative analytical efforts.

A systematic review of high-quality studies with randomization, such as RCTs, is preferable to conducting an actual experimental study due to two reasons. Firstly, in my current setting, it could be problematic to control participants adherence to the selected teeth brushing protocol to ensure equal conditions. Secondly, a single study with two groups of patients would be inevitably limited to testing one specific toothbrush model, which would affect the generalizability of results (Grender, Adam, & Zou, 2020). Instead, attempts to systematize the results of available studies would help to provide a more credible answer to the stated PICOT question and even make comparisons between different manufacturers products to provide recommendations for patients.

Conclusion

In summary, the emergence of new tools for dental care at home has promoted patients opportunities for implementing dental hygiene practices to the next level. The PICOT question proposed in this paper aims to translate this variety into better dental health outcomes for those with gingivitis. The question related to OR toothbrushes advantage over manual toothbrushes could be addressed in quantitative studies, such as the reviews of RCTs.

References

Ccahuana-Vasquez, R. A., Adam, R., Conde, E., Grender, J. M., Cunningham, P., Goyal, C. R., & Qaqish, J. (2019). A 5-week randomized clinical evaluation of a novel electric toothbrush head with regular and tapered bristles versus a manual toothbrush for reduction of gingivitis and plaque. International Journal of Dental Hygiene, 17(2), 153-160.

Grender, J., Adam, R., & Zou, Y. (2020). The effects of oscillating-rotating electric toothbrushes on plaque and gingival health: A meta-analysis. American Journal of Dentistry, 33(1), 3-11.

The Argument For the Essay

I agree with Afshan Jafars article because it emphasizes how praising people for being thin reinforces detrimental ideals on body image. While punishment in the form of fat-shaming is often harmful to an individuals self-esteem, positive reinforcement in the form of praise for a thin body is worse. In the end, detrimental views and practices regarding beauty and body image prevail (Jafar 68). I was drawn to this article because societys narrow definition of the ideal body type has caused my friends endless agony as they strive to achieve a thin physique. In addition, a majority of media outlets and social influencers equate being thin to being healthy. It is vital to point out that not all thin individuals are healthy, and not all fat people are unhealthy. In addition, fat people who engage in exercise are often healthier than thin individuals who do not work out.

Thin praising is fundamentally identical to fat-shaming because it emphasizes the negative attributes associated with being fat. It is often assumed that fat individuals are lazy, unhealthy, and unattractive. There is a prevalent belief that these individuals constantly make bad choices, unlike their thin counterparts who work hard to maintain a petite physique (Jafar 68). I agree with the emphasis on the fact that praising thin people is more detrimental than fat-shaming. Overweight individuals often feel like they do not fit in because even though they may not be targeted by fat-shaming comments, the praise given to their thinner colleagues serve to ostracize them. It is vital to note that while efforts to lose weight should be encouraged, offering praise and media attention to individuals who achieve societys definition of the ideal body must be discouraged.

The Claim-Driven Argument Against the Essay

It is essential to note that a majority of people in society desire to be acknowledged for their efforts. Gaining recognition for achieving a set goal often motivates individuals to improve. The aforementioned idea is highlighted in Maslows hierarchy of needs which highlights that in situations where basic needs are fulfilled, the desire for acceptance increases. Afshan Jafar is of the view that praising individuals for weight loss is as harmful as fat shaming. While fat-shaming is universally known to cause detrimental health effects, praising people for losing weight is in no way harmful. The following review will demonstrate the effectiveness of praise, its psychological benefits, and its ability to inspire healthy living.

It is vital to note that when people feel appreciated for losing weight, they feel safe and energized. It is vital to note that the pressures of urbanization and modernity significantly increase the risk of depression, which means there is a need to foster positivity through praise. A few important lessons are evident in the early education system. Kindergarten teachers place emphasis on praise in view of the fact that it reinforces positive behavior. It is critical to rationalize praise by offering specific details regarding the activity the individual succeeded at accomplishing. The persons effort to lose weight must be praised in order to encourage them to maintain their new lifestyle.

Obesity is a challenging health problem for a number of nations across the world. According to the World Health Organization, global obesity has tripled since 1975, with approximately 1.9 billion people categorized as either overweight or obese in 2016 (Jane et al. 1). The health challenge has reached epidemic proportions, with an increasing number of individuals getting affected every year. The increase in the use and consumption of social media content provides an important avenue through which the issue can be addressed. The use of social media services to reach target groups has evolved into an art (Goldberger 74). Contrary to the views proposed by Afshan Jafar, praising individuals for losing weight is an effective way of ensuring others in a similar position take action and work towards improving their health. A systematic review of health information access revealed that social media has the ability to reach sections of the populations that are often isolated from medical promotions. Therefore, providing these audiences with a practical example of an individual that worked to lose weight for purposes of leading a healthy lifestyle is crucial.

Creating an interactive social media page where health professionals praise individuals for their achievements with regard to weight loss is critical. A trial conducted on Twitter that featured a Twitter-based social support program demonstrated an association between the degree of usage and weight loss (Jane et al. 5). The emotional support the participants offered each other was instrumental in ensuring that the people stuck to the program and achieved statistically significant results. It is worth noting that the praise offered to individuals as they lost weight served to bolster their confidence and inspire dedication. Weight loss programs that utilize social media platforms encourage the exchange of social support, which helps participants achieve their set goals and objectives.

It is vital to note that praise boosts self-esteem in addition to encouraging autonomy. In addition, it provides incentives for engaging in the task in question. In this case, praising an individual for losing weight will prompt them to engage in exercise and eat healthy, which is essential for their overall wellbeing. There are specific steps that should be taken when praising an individual for achieving a normal body weight. First, the feedback must be immediate if its effects are to be reflected in the individuals life. In addition, specificity is key so that the individual understands why their efforts are being appreciated. It is also essential to avoid mixing positive and negative feedback if confusion is to be avoided. Finally, it is vital to frame the achievement in the context of the bigger picture. For instance, losing weight not only makes the individual look better but also ensures longevity by promoting health.

The most effective form of praise is contingent praise that is given when the desired behavior is observed. It is particularly effective in dealing with behavioral problems at an individual level. For instance, if an individual with poor eating habits is praised, the likelihood that they will adopt a healthier diet increases significantly. Process praise should also be encouraged in view of the fact that it encourages individuals to focus on remedies and identify new strategies to solve persistent problems (Glerum et al. 1270). It should be noted, however, that the effectiveness of praise is context-dependent. It is critical to avoid coming across as desperate or condescending when congratulating an individual after they lose weight.

There are numerous health benefits to achieving a normal weight. For instance, excessive weight in childhood predicts serious morbidities later in life, such as diabetes, malignancies, and heart disease (Brewis and Bruening 1). In addition, a large proportion of overweight individuals suffer from depression. A meta-analysis revealed that clinically obese adolescents had a 40% higher risk of developing depression (Brewis and Bruening 1). Therefore, efforts made by individuals to limit the risk of developing serious health complications in the future must be lauded.

It is critical to point out that fat-shaming is different from thin praise. The former has serious adverse effects on health while the latter promotes wellbeing. Presenters at the Canadian Obesity Summit note that fat-shaming is harmful in view of the fact that it promotes weight gain (Vogel 649). Fat-shaming leads to behavioral and psychological changes that are associated with poor metabolic health and increased weight. Increases in levels of cortisol due to the stress associated with dealing with fat-shaming comments lead to the loss of self-control and an increase in binge-eating. Praising thin individuals works in the opposite manner because it encourages individuals to continue working towards achieving their desired weight.

Individuals who lose weight should be praised because their efforts have numerous health benefits. Losing between 5-10% of body weight leads to significant improvements in blood pressure, blood sugars, and cholesterol (Centers for Disease Control and Prevention). This prevents ailments such as hypertension, diabetes, and heart disease. In addition, praise goes a long way in helping obese individuals overcome negative body image issues. Studies have consistently demonstrated the fact that a positive body image is inextricably linked to higher self-esteem (Katz). Therefore, praising an individual who has lost weight helps boost self-esteem and reinforces positive perceptions of body image.

Afshan Jafars assertion that praising thin people promotes detrimental health outcomes is untrue. While thin people are susceptible to illness, overweight and obese individuals stand a higher risk of developing non-communicable diseases that are often difficult to manage. A number of health professionals and research studies advocate for the attainment of physiologically ideal weight to ensure illnesses are kept at bay. It is also essential to note that for a majority of individuals diagnosed as obese overweight, specific lifestyle choices are the primary causes of their illness. Most affected individuals lead sedentary lifestyles with very little physical activity. In addition, their diets are often filled with processed foods, sugar, and preservatives, which lead to abnormal weight gain. Their refusal to change their habits leads to depression which is oftentimes characterized by increased feeding and further isolation. The vicious cycle continues, and it becomes increasingly difficult to lose weight.

It is evident that losing weight is a difficult and often frustrating endeavor. Breaking the cycle of unhealthy habits often requires significant effort. Therefore, it is important to praise individuals who have worked hard to achieve normal body weight. The recognition is critical because it helps prevent relapses and ensures that affected individuals adopt a healthy lifestyle. In addition, the efforts serve to motivate others facing a similar challenge. Witnessing the praise offered to an individual who has successfully lost weight motivates overweight and obese individuals to make changes in their lives. Even though Afshan Jafars views bear some truth, they fail to highlight the positive psychological impact of praise and the overall effect it has on individuals struggling to lose weight. The thin bodies they see on social media and the real stories of weight loss inspire them to make important life changes.

Works Cited

Brewis, Alexandra A., and Meg Bruening. Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence. International Journal of Environmental Research and Public Health, vol. 15, no. 5, 2018, pp. 112, Web.

Centers for Disease Control and Prevention. Losing Weight: Healthy Weight, Nutrition, and Physical Activity . 2020.

Glerum, Jaap, et al. The Effects of Praise for Effort versus Praise for Intelligence on Vocational Education Students. Educational Psychology, vol. 40, no. 10, Routledge, pp. 127086, Web.

Goldberger, Paul. Disconnected Urbanism. Arguing About Literature: A Guide and a Reader, edited by John Schilb and John Clifford, Macmillan Learning, 2020, pp. 74-75.

Jafar, Afshan. Not a Fan of Fat Shaming? Stop Thin Praising. Arguing About Literature: A Guide and a Reader, edited by John Schilb and John Clifford, Macmillan Learning, 2020, pp. 67-68.

Jane, Monica, et al. Social Media for Health Promotion and Weight Management: A Critical Debate. BMC Public Health, vol. 18, no. 1, 2018, pp. 17, Web.

Katz, Shirley. Body Image. GoodTherapy, 2019.

Vogel, Lauren. Fat Shaming Is Making People Sicker and Heavier. Cmaj, vol. 191, no. 23, 2019, p. 649, Web.

The Importance of Medication Reconciliation

Medication reconciliation refers to a formal procedure for developing the most accurate and complete listing possible of a patients recent medicines and comparing it to those included in the drug orders or patient records. The aforementioned process is done to avert medication errors such as drug interactions, dosing errors, duplications, and omissions. These errors may arise from the inadequate understanding of ones present and past medical treatment.

The Strategies to Prevent Medication Errors

Healthcare practitioners may utilize patient identifiers, highlight crucial conditions and diagnoses, verify reactions and allergies, update patients current drugs, and standardize weight and height measurements to avoid medication errors. Physicians also need to have adequate drug information; this can be reinforced by maintaining medication references, distinguishing high-alert medications, and establishing guidelines. Alhagh et al. (2016) further underscore the importance of effective communication, e.g., the use of electronic systems as an approach to avoiding medication errors. Proper storage and labeling of drugs, quality patient education, and proper drug devices can also be used to prevent these errors.

The Effect of Maturation on the Elements of Pharmacokinetics

High gastric pH in young infants and neonates has a protective effect/influence on acid-labile medications and accounts in part, for the increased beta-lactam antibiotics bioavailability. During the neonatal phase, the gastric emptying period is longer than that of an adult; it is partly liable for the delayed absorption of orally administered sulfonamides, digoxin, and phenobarbital (Anker et al., 2018). Developmental modifications in the activity of intestinal medication transporters and metabolizing enzymes can potentially alter drugs bioavailability. Age-dependent changes in pancreatic enzymes activities and biliary function can compromise the bodys capacity to solubilize and absorb specific lipophilic medications.

Plasma protein binding of medications is typically decreased in infants and neonates. Reduced protein binding may trigger a high drug distribution from plasma to the body. Developmental changes which occur in enzymatic systems, according to Anker et al. (2018), have been supported by age-related modifications in the clearance of multiple drugs and metabolic ratios. Glomerular filtration rate (GFR) increases depending on the chronological age since delivery. For medications excreted primarily through glomerular filtration, initial dosage adjustments can be made by decreasing dosage or elevating dosing intervals. Tubular secretions evaluated by p-aminohippurates renal clearance are lowered at birth to around 20-30 percent of adult volume but mature by fifteen months.

References

Alhagh, E., Gorgich, C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global Journal of Health Science, 8(8), 220227. Web.

Anker, J., Reed, D. M., Allegaert, K., & Kearns, L. G. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58(S10), S10  S25. Web.

Introduction

Congenital heart defects (CHD) introduce a serious public health concern that may occur in the heart during the prenatal development of a fetus. The Centers for Disease Control and Prevention (2017) states that about 1% (40,000) of children are born with such defects in the United States annually, and 25% of these children have a critical condition. Babies with CHDs may look absolutely normal, but become critically ill or even die in a short period. Therefore, the detection of heart defects by such a method as fetal echocardiography is important. The purpose of this paper is to investigate the worth and accuracy of fetal echocardiography for congenital cardiac defects in a fetus using the studies published during the last five years.

Fetal echocardiography is a diagnostic technique that was introduced by Winsberg in 1972 (Liu, He, Li, & Zhang, 2014). This test is usually performed at 12-16 gestational age to screen for heart malformations. Its significance cannot be neglected because it may define a future intervention therapy, including surgery, prenatal care management, and postnatal improvements. Not all pregnant women are in need of fetal echocardiography. As a rule, it is enough to use a basic ultrasound for heart investigation. However, fetal echocardiography is recommended for mothers who have heart disease or other medical conditions that may influence the work of the heart, use drugs, alcohol, or medications that affect the heart or have a similar family history.

In this paper, prenatal diagnosis of fetal congenital cardiac abnormalities with the help of fetal echocardiography has been shown to have a significant impact on prenatal and postnatal management and outcomes on babies.

Congenital Cardiac Defects

Fetal echocardiography is a necessary tool in prenatal screening and diagnosis because it helps to define what kind of cardiac defect a fetus and explain what kind of problems a future baby may have. There are several main congenital cardiac defects that may be defined after mothers are diagnosed with the help of fetal echocardiography: hypoplastic left and right heart syndrome, L-TGA and D-TGA, truncus arteriosus, and interrupted aortic arch.

Hypoplastic Left & Right Heart Syndrome

Hypoplastic left and right heart syndromes are severe congenital cardiac malformations that affect a normal blood flow in the fetus heart when blood supply depends on patency of the arterial duct (Clausen, 2015). Hypoplastic right heart syndrome (HRHS) is a rare condition among neonates that occurs when the right side structure of the heart remains to be undeveloped and influences the work of the heart chambers, valves, and blood vessels, and the amount of oxygen pumped from the heart to the lungs (Mohan, Mohan, Shukla, & Sethi, 2016). A pulmonary valve atresia is not formed, and tricuspid valve, as well as right ventricle and the pulmonary artery, are of a small size leading to numerous problems of pumping blood. Fetal echocardiography is used to define the sizes of valves.

Hypoplastic left heart syndrome includes changes and defects of the left side of the heart. During the prenatal development, this side of the heart can be formed in a wrong way, and certain malformations are observed. For example, the left ventricle is too small and nonviable, and mitral or aortic valves are not formed and have to be replaced (Rychik, 2014). The result of such malformations is the inability of this side of the heart to pump blood through the body and the necessity of the right side of the heart to work twice harder. The causes of this syndrome are still unknown, and the only solution that can be given in a heart transplant.

L-TGA and D-TGA

Transposition of the great arteries is a serious and one of the most common congenital cardiac defects that may be diagnosed by fetal echocardiography. It is a reversal of arteries which take responsibility for blood circulation in the heart (Unolt et al., 2013). There are two types of this condition: l-TGA (levo-transposition of the great arteries) and d-TGA (dextro-transposition of the great arteries). L-TGA is less dangerous for babies than d-TGA because of the reversal of two main arteries when the body is still able to receive oxygen-rich blood. The work of the arteries and their functions predetermine the way of how blood is circulated in the body. As soon as one tiny change occurs in a circulation process, there is a threat of having the shortage of oxygen in the blood and serious complications which lead to death. Fetal echocardiography can be used to detect this defect prenatally and observe the position of the aorta and the pulmonary artery in order to get prepared for corrective surgery right after a child is born.

Truncus Arteriosus

In the list of rare heart defects, truncus arteriosus takes one of the leading places because it is characterized by a single blood vessel coming out of the heart instead of a usual pair of vessels (Kumar, Devi, & Ghosh, 2017). It also leads to the creation of a hole between the lower chambers of the heart. Due to such complications, the blood that is rich in oxygen and the blood that lacks oxygen are mixed up and circulated in the body causing new problems. A fetal echocardiogram can show the structure of the heart and the work of each vessel in it. If one vessel leading from the heart and a hole between the ventricles are observed, truncus arteriosus may be diagnosed.

Interrupted Aortic Arch

Interrupted aortic arch (IAA) is a serious heart defect with a portion of the aortic arch being absent or discontinued. It is a rare genetic disorder that is usually associated with other heart defects and divided into three main types in regards to the results obtained from fetal echocardiography (Zhang et al., 2016). The location of the interruption defines the type of IAA: the first type (A) includes the malformations beyond the left subclavian artery, the second type (B) comprises the interruptions between the left carotid artery and the left subclavian artery, and the third type (C) introduces the interruptions which occur between the innominate artery and the left carotid artery (Park, 2014). An echocardiogram can be used to identify the type of interruption and give a proper diagnosis.

Associated Syndromes

Congenital heart diseases are usually accompanied by certain genetic syndromes and complications which show cardiac abnormalities. Ko (2016) suggests paying attention to such associated syndromes as Down syndrome, Williams syndrome, Turner syndrome, Noonan syndrome, and 22a11.1 deletion syndrome also known as DiGeorge syndrome. To succeed in diagnosing and treating congenital heart disease, clinicians have to understand the genetic etiology of every patient and learn the peculiarity of every anomaly and its genetic background.

Genetic causes of heart problems among neonates continue increasing today, and clinicians have to work hard to comprehend how to combine different symptoms and factors and come to the same conclusion (Fahed, Gelb, Seidman, & Seidman, 2013). Down syndrome is the abnormality caused by the presence of a third copy chromosome 21 that leads to certain intellectual disabilities, joint laxity, and cardiac defects (Ko, 2016). A disorder that is based on a microdeletion of chromosome 7q11.23 is known as Williams syndrome (Ko, 2016). Children with such syndrome usually have aortic stenosis and other cardiac malformations. Turner syndrome is observed among live born girls with specific cardiovascular malformations. This syndrome is caused by the absence of the second X chromosome that leads to a short stature and affected organ systems. Noonan syndrome is characterized by various phenotypes, including mild developmental delay, webbed neck, and lymphatic dysplasia. This syndrome may be detected by electrocardiogram or echocardiogram at the initial evaluation of a fetus. People with DiGeorge syndrome, or 22a11.1 deletion, differ from others due to a long face, downturned mouth, high nasal bridge, and small teeth. The combination of this syndrome with congenital heart defects turns out to be one of the leading causes among neonates. Therefore, early detection of these problems can save human lives.

Prenatal Care after Diagnosis

A fetal echocardiogram is one of the most reliable methods for giving prenatal diagnoses and make prenatal improvements possible. In many cases, congenital heart defects are treated by means of congenital heart surgeries. However, if there is a change to diagnose such defects prior to birth, successful coordination of delivery and prenatal counseling can help many families (Quartermain et al., 2015). In the United States, this type of assessment is not as frequently used as in other countries. Still, the US government and health associations take numerous steps to change this situation and provide future mothers with all necessary equipment and material to use the benefits of prenatal diagnosis. In the period from 12 till 16 gestational weeks, fetal echocardiography can be used to screen for fetal heart defects (Hutchinson et al., 2017). Some families agree to take this test and be the fetus screened for abnormalities. Some families reject this idea in order to stay as unaware about possible challenges as possible.

On the one hand, prenatal care and diagnosis may help parents and the medical staff get prepared for a special condition, choose fetal surgery if possible, and facilitate the process of fetus development. On the other hand, there are the situations when nothing can be done to help the fetus, and parents have to live with a thought that their baby can be born and die in a short period. It is the solution for parents to use or avoid prenatal care and diagnosis.

Postnatal Care and Management

Children with congenital heart defects have to be treated properly. Care and management play an important role because it may be long-term with the necessity to monitor the condition of a baby and short-term when one surgery is enough to solve a heart problem. In addition to surgery, babies with heart defects may use a heart transplantation option. Still, it is not always available to all patients, it is expensive, and wait time may be incompatible with a childs condition (Hutchinson et al., 2017). Doctors also suggest neonate patients taking medications (inhibitors or beta blockers) that can facilitate the work of the heart, decrease the cases of depression, and control the level of blood.

Postnatal management should also include the discussion of the restrictions which cannot be neglected by children with congenital heart defects and their parents. As a rule, such children cannot run or climb trees, should avoid spicy food and physical exercises, and think about calm hobbies and spheres of interest. Finally, clinicians have to inform their patients about an increased risk of infections and their possible impact on the heart. Sometimes, one infection may cause serious damage to the heart that cannot be repaired. Parents should take responsibility for their sick children and make sure they offer enough comfort under different conditions.

Advantages and Disadvantages of Fetal Echocardiography

Taking into consideration the offered material about the existing congenital heart defects, their outcomes, and associated syndromes, some people start doubting about the importance of fetal echocardiography. A fetal echocardiogram is used to create a picture of the fetus heart and provide parents and clinicians with a chance to learn if a future child may be exposed to some heart defects. The positive aspects of fetal echocardiography include awareness of and confidence in the presence/absence of heart defects in a fetus, a possibility to improve the condition with the help of fetal surgery, and the provision of time to be prepared for delivery and care management, including correctional surgery or other interruptive steps. As soon as a cardiologist has enough information, it is possible to provide the family with information and counseling regarding the specific health condition of the fetus, identify the anticipated prognosis, and think about the most appropriate management steps. Fetal cardiac surgery may play a crucial role in fetal medicine and the lives of millions of American families. If there is a chance to identify a heart problem in the fetus, there is also a chance to find effective treatment and reduce the number of risks associated with the problem.

However, there are also several disadvantages of fetal echocardiography that people have to be aware of. For example, not all people want to know if their future children may have heart defects. Still, the presence of such possibility makes them think about what they can use to improve the life of their future babies and what they should never do. Numerous ethical and emotional problems can be raised around the necessity of fetal echocardiography. Besides, the results of fetal echocardiography are not always correct. Not a single doctor takes responsibility that no heart problems can be observed in children as soon as they are born. The only conclusion that can be made is that at the moment, no abnormalities are observed.

Conclusion

In general, the future of fetal echocardiography is safe. This diagnostic method may help millions of children to improve their health conditions, even if they have congenital heart defects and prepare their families for special conditions. In the United States, not all families are aware of the effects and urgency of fetal echocardiography. Therefore, it is necessary to think about the methods which can be used to educate people about fetal echocardiography and make them decide confidently. Prenatal diagnosis of fetal congenital cardiac anomalies plays an important role in pre- and post-natal management and care offered to babies. Still, it should be an individual decision of every woman whether to use fetal echocardiography for screening for heart defects or stay unaware till delivery hoping that everything can be good for her and her baby.

References

Centers for Disease Control and Prevention. (2017). Congenital heart defects. Web.

Clausen, H. (2015). Hypoplastic left heart syndrome. Paediatrics and Child Health, 25(1), 18-22.

Fahed, A.C., Gelb, B.D., Seidman, J.G., & Seidman, C.E. (2013). Genetics of congenital heart disease: The glass half empty. Circulation Research, 112(12). Web.

Hutchinson, D., McBrien, A., Howley, L., Yamamoto, Y., Sekar, P., & Hornberger, L.K. (2017). First-trimester fetal echocardiography: Identification of cardiac structures for screening from 6 to 12 weeks gestational age. Journal of the American Society of Echocardiography, 30(8), 763-772.

Kumar, P., Devi, A., & Ghosh, G. (2017). An infant with truncus arteriosus with situs inversus with single atrium: A case report. Journal of Cardiology Cases, 15(3), 107-109.

Liu, L., He, Y., Li, Z., & Zhang, L. (2014). Application of two-dimensional echocardiography combined with enhanced flow in diagnosing fetal heart malformation. Clinical and Experimental Obstetrics & Gynecology, 41(2), 195-201.

Mohan, J.C., Mohan, V., Shukla, M., & Sethi, A. (2016). Hypoplastic right heart syndrome, absent pulmonary valve, and non-compacted left ventricle in an adult. Indian Heart Journal, 68(2), 229-232.

Park, M.K. (2014). Pediatric cardiology for practitioners (6^th ed.). Philadelphia, PA: Elsevier Health Sciences.

Quartermain, M.D., Pasquali, S.K., Hill, K.D., Goldberg, D.J., Huhta, J.C., Jacobs, J.P., & Ungerleider, R.M. (2015). Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics, 136(2), 378-285.

Rychik, J. (2014). Hypoplastic left heart syndrome. Circulation, 130, 629-631.

Unolt, M., Putotto, C., Silvestri, L.M., Marino, D., Scarabotti, A., Massaccesi, V., & Marino, B. (2013). Transposition of great arteries: New insights into the pathogenesis. Frontiers in Pediatrics, 1(11). Web.

Zhang, D., Zhang, Y., Ren, W., Sun, F., Guo, Y., Sun, W., & Cai, A. (2016). Prenatal diagnosis of fetal interrupted aortic arch type a by two-dimensional echocardiography and four-dimensional echocardiography with b-flow imaging and spatiotemporal image correlation. Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques, 33(1), 90-98.

More than 11 percent of Mexicans living outside Mexico. This has made the country have the highest number of emigrants in the world. Moreover, the highest number of these emigrants, live in the United States. That is why between 50% and 90% of U.S. emigrants have a Hispanic origin (Bean, 1997).

It is significant to note that 90% of the Hispanics in Durham, for example, were low-skilled residents. Durham city had a lot of employment opportunities because of the large number of hospitals, universities, and companies like GlaxoSmithKline Kline (Bean, 1997). As a result of racial inequality, the natives were employed at the top, managerial positions while the Hispanics were employed as low-wage casual workers. This made their lives miserable in a foreign land. Moreover, the already overpopulated Hispanics lived in slums under unhygienic conditions such as poor drainage, poor sanitation, and poor ventilated houses (Bean, 1997). This led to regular outbreaks of water-borne diseases like diarrhea in the slums. There was also a frequent outbreak of tuberculosis that would claim the lives of most Hispanics whenever it happened. Consequently, there was a migration stream in which the majority of men emigrated. Men were highly demanded construction work. This led to an unequal sex ratio among Hispanics. For instance, Bean (1997) analyze that more than two men shared one woman. This led to increased HIV/AIDs infections. Sometimes, men opted to go for sex workers and made the situation worse. Apart from HIV/AIDs, other STDs like gonorrhea and syphilis were common among the Hispanic population.

Barriers: What are potential barriers that may arise during teaching and how will those be handled?

Language barrier

Language barrier occurs when the person sending a message and the person receiving it cannot communicate because of language differences. When handling the topic of unsanitary living conditions language barriers can arise. This is likely to occur if the teacher and the student do not have a common language instruction (Lundy & Janes, 2009). If this occurs, it will be important for the teacher to hire a translator to act as a bridge between the teacher and the learners. This way, the message will be delivered.

Disability

Disability is not limited to blindness and deafness. If the educator has a blind or deaf learner, it will be difficult to deliver the message (Lundy & Janes, 2009). For instance, if the educator is demonstrating how a fire extinguisher is used to put off the fire, a blind learner will miss the demonstration part. This situation can be handled by referring the disabled student to special tutors trained to deliver special lessons in a way they can understand (Lundy & Janes, 2009). For instance, a blind person can be taught using braille while deaf can be taught using sign language. Other potential barriers include cultural barriers, inflexible curriculum, and lack of supportive learning materials.

Nursing Diagnosis: unsanitary living conditions

Nursing diagnosis is a clinical judgment on an individual or group of individuals regarding their response to the actual health problem at hand. The diagnosis gives a basis for selecting the best nursing intervention for effective treatment results (Brokel & Heath, 2009).

As for the case of unsanitary living conditions, there are various nursing diagnoses. For instance, if a patient has diarrhea, the nurse is likely to judge the patient to have drunk unclean water or contaminated food. If a patient has a skin disease like scabies, the nurse could quickly judge that the patient is not observing proper personal hygiene.

References

Bean, F. D. (1997). At the Crossroads: Mexico and U.S. Immigration Policy. New York: Lanham, Rowman & Littlefield Publishers, Inc.

Brokel, J., & Heath C. (2009). The value of nursing diagnoses in electronic health records. Wiley-Blackwell: Singapore

Lundy, K. S., & Janes, S. (2009). Community health nursing: Caring for the publics health (2nd ed). Sundbury, MA: Jones and Barlett.

Introduction

Nowadays, animal bites are common (Rothe, Tsokos, & Handrick, 2015). Consequently, treating them promptly is essential, as, otherwise, it may lead to health complications. The primary goal of this paper is to describe the initial treatment, determine the most effective choices of antibiotics, and define follow-up care. In the end, it is essential to identify the cases when suturing of wounds is appropriate.

Initial Treatment

Firstly, it is essential to determine the procedures that have to be performed in the emergency setting. It is only rational to review medical history and past treatment only if a patient is in stable condition (Rasmussen, Landon, Powell, & Brown, 2017). In this instance, asking him/her about different chronic illnesses and bite circumstances can help define the most appropriate action plan and treatment. Nevertheless, if the patient is unstable, it is of paramount importance to stabilize his/her condition by ensuring sufficient air circulation and stopping bleeding (Rasmussen et al., 2017). Only after that, it will be reasonable to conduct a subjective assessment.

After the stabilization of the patient, it is vital to assess the severity of the wound, classify it, determine its key features (length, size, and effect on motion), and evaluate if there are any symptoms of infection (Rasmussen et al., 2017). Along with that, it is of high importance to disinfect the wound quickly, as, skipping this procedure, may lead to adverse health consequences. This phase includes the following steps: 1) disinfect the area around the wound with 1% povidone-iodine; 2) treat the wound itself with 0.9% sodium chloride solution (use catheter to clean the wound profoundly); and 3) inspect the wound and remove any foreign objects and debris from it (Rasmussen et al., 2017). In case of other complications and after these steps, the patient has to be taken to the hospital immediately.

Choices of Antibiotics

Apart from the actions mentioned above, the role of antibiotics cannot be underestimated, as the wounds from mammalian bites are vulnerable to infections (Evgeniou, Markenson, Iyer, & Armstrong, 2013; Rothe et al., 2015). Some of the studies indicate that antibiotic therapy is not compulsory, especially, if the wound is insignificant. However, it is critical to undergo this therapy in the cases such as 1) deep bites; 2) cat bites; 3) bites location close to the genitals, face, and joints; and 4) severe condition of the injuries (Rasmussen et al., 2017). Consequently, if the antibiotic treatment is necessary, one of the possibilities is amoxicillin/clavulanate (a three-to-five-day course) (Rasmussen et al., 2017). If the patient is allergic to the components of the indicated antibiotics, other options are clindamycin plus ciprofloxacin, clindamycin plus sulfamethoxazole-trimethoprim, and azithromycin (Rasmussen et al., 2017). This treatment is only applicable to the patients with the cases stated above. In severe situations, hospitalization and usage of IV antibiotics may be necessary.

Follow-up Care

Thus, in the case of mammalian bites, follow-up treatment is a requirement, as it is of critical significance to monitor any changes in the condition of the patient. Thus, before prescribing particular antibiotics, it is necessary to conduct a diversity of tests to determine any specifics and complications such as bone injuries (Rasmussen et al., 2017). It may be essential to evaluate the flora of the bite to determine the nature of the infection, as saliva of different animals contains various bacteria. For example, dogs one may have Moraxella, Enterobacter, and Staphylococcus (Auerbach et al., 2016). A combination of these factors along with the analysis of the patients medical history help prescribe the right antibiotics and determine the necessity of vaccination from tetanus and rabies, as it may not be required in a limited number of cases.

In turn, if the wound affects the functioning of other systems, referring to other specialists may be a necessity, as surgery may be required (Rasmussen et al., 2017). Thus, after prescribing the treatment, the number and frequency of follow-up visits are highly dependent on the severity of the wound and the condition of the patient. For example, if a patient has a wound will a low risk of infection, only one visit in two days may be required (Auerbach, Cushing, & Harris, 2016). In other cases, more visits may be compulsory, especially, if any infection is present. Lastly, follow-up care requires covering aspects such as patient education, as it is of high significance to explain the current condition, importance of following the prescription, ways of treating the wound, and various prevention strategies (Bastable, 2016; Murtagh, 2016). It will help the patient to recover from emotional stress, deal with mental pressure, and avoid wound infection and accompanying complications.

Conclusion: Suturing of Wounds

Previous sections provided a profound analysis of examination, treatment, usage of antibiotics, and follow-up care. Nevertheless, another critical point to discuss is suturing of wounds. This procedure is dependent on the condition of the wound (Rasmussen et al., 2017). In the majority of the cases, suturing is required for cosmetic reasons or to prevent the spread of infection in wounds occurred less than 12 hours ago. To deal with these issues, subcutaneous suturing has to be utilized, as doing it differently may lead to inflammation of tissues and other adverse consequences (Rasmussen et al., 2017). Thus, here is the list of situations when suturing is forbidden: 1) crush injuries and puncture wounds; 2) wounds of legs or arms occurred more than 12 hours ago; 3) face wounds that took place more than 24 hours ago; 4) human bites of joints; and 5) bite wounds among patients with immune systems issues. To summarize, considering all specifics mentioned above is of extreme importance, as any wrong actions will lead to adverse consequences.

References

Auerbach, P., Cushing, T., & Harris, N. (2016). Auerbachs wilderness medicine. Amsterdam, Netherlands: Elsevier Health Sciences.

Bastable, S. (2016). Essentials of patient education. Burlington, MA: Jones & Bartlett Publishers.

Evgeniou, E., Markenson, D., Iyer, S., & Armstrong, A. (2013). The management of animal bites in the United Kingdom. Eplasty, 13(1), 27.

Murtagh, J. (2016). Murtaghs patient education. New York, NY: McGraw-Hill Education.

Rasmussen, D., Landon, A., Powell, J., & Brown, G. (2017). Evaluating and treating mammalian bites. JAAPA, 30(3), 32-36.

Rothe, K., Tsokos, M., & Handrick, W. (2015). Animal and human bite wounds. Deutsches Arzteblatt International, 112(25), 433-443.

Medication assistance programs are an integral element in providing quality healthcare services to the community. Every member should have access to healthcare; it is unthinkable and unfair that financial constraints can deny access to different forms of healthcare. Medication assistance programs serve as a safety net for those in communities who are not financially secure to afford medication (Khan et al., 2018).

The task force required to design the medical assistance program should be adept at having a maximum positive impact on the less privileged in need of prescription drugs and other forms of treatment. Some of the stakeholders I would ensure are included in the task force comprise prescribers, financial navigators, suppliers, bookkeepers, and subsidizers. Their expertise is essential in making the medication assistance program a success.

Medication assistance programs are meant to assist those who cannot fund their medications, such as individuals lacking insurance coverage. However, in some cases, for example, cancer, the health expenses are more than what the insurance can cover. Financial navigators offer financial literacy to patients about their treatment and help them arrive at the best decision. Financial navigators are necessary to help people receive cost-saving treatments that are manageable to the program and help patients who are not wholly covered by insurance assess their options.

Prescribers are responsible for making the treatment decision for patients based on the patients diagnosis, characteristics, and laboratory findings. Prescribers would be vital since they would recommend the optimal treatment for patients suffering from different ailments. A prescriber would be resourceful in the task force because they offer advice on the drugs that should be stocked to help patients suffering from a particular disease/condition.

A bookkeeper serves roles that are key to the functioning of the medication assistance program. Some of them include keeping stock of the drugs available and keeping track of all the incomes and the various expenditures incurred. Bookkeepers ensure accountability within the program, hence reducing irregular expenditure and misappropriation of funds meant for the program. Bookkeepers are integral in decision-making made as they update all stakeholders on the financial position of the program, thus dictating whether a decision is financially sustainable.

High premiums are the main reason why most people do not have medical cover. One of the critical roles of the program is to make them affordable to ordinary citizens. Subsidizers are tasked with offering subsidies to a select group genuinely in need of subsidies. Subsidizers facilitate and encourage even the less privileged to have medical cover. Medical covers for everyone will ensure access to healthcare attention when a need arises. In the group, a subsidizer would be resourceful in helping patients who have financial constraints obtain a subsidized medical cover which would help them.

Suppliers are an integral part of a medical assistance program. Besides availing of drugs and therapeutic supplies, they can access the best medical resources and the latest medical technology. Suitable suppliers would help acquire quality medical supplies at the best prices. They will also help in prioritizing products as they are aware of the availability of those products. Having a supplier in the task force would help save costs by acquiring top-quality products at the best prices.

I would choose the prescriber to be the group facilitator. This is because they are conversant with the medical field and specifically in administering medication. The prescriber is the best place to facilitate all the operations of the program. With the task forces support, I intend to improve and facilitate access and adherence to prescribed medication to the uninsured population and to help as many financially constrained people have medical covers as the resources allow. We aim to achieve this goal by having all stakeholders work diligently to help as many financially disadvantaged populations have access to healthcare services as possible.

Reference

Khan, G., Karabon, P., & Lerchenfeldt, S. (2018). Use of prescription assistance programs after the Affordable Health Care Act. Journal of Managed Care & Specialty Pharmacy, 24(3), 247-251.

Physical Environment

Although available data shows that the Kiryas Joel community has a total area of 1.1 square miles (2.8 km2), physical observations do not reveal any boundaries within the community apart from the fact that it is located close to the neighboring towns of Blooming Grove and Woodbury. There are no commercial streets in the community, though the neighborhood has an identity as a Jews community. In housing, much of the area is given over to residential property although new construction is ongoing throughout as demonstrated by upcoming modern townhouse-style condominiums mostly used for multi-family dwellings due to the large size of families. However, zoning of the housing developments in the community has not been effectively coordinated, and it is evident that the developers do not rely on any plan during construction.

People

Most of the residents in the community comprising 18,300 people are Hasidic Jews, who passionately observe the Torah and its teachings. The community is not homogenous when racial or ethnic variables are considered due to the sizeable proportion of immigrants of Hungarian ancestry. There are a few African Americans and Asians noted, though there are no overt indicators of ethnicity observed within the community. Most of the people in the community engage in healthy eating habits as demonstrated by the high number of sheds selling a wide variety of fruits and vegetables, as well as parlors selling natural honey and milk. Similarly, the central pillar of religion in the community ensures that most people do not engage in risk behaviors such as alcoholism or drug abuse. Poverty is high in the community due to high population growth and the fact that the area has the lowest per capita income (approximately $4,355) of any community with over 10,000 people in the United States.

Services

Health services are provided by two health facilities owned by the town council and one private health institution with religious underpinnings. These facilities have no capacity to provide mental health services and are inconveniently located within the peripheries of the community. The two schools built and operated by the town council are inadequate and overcrowded, hence unable to meet the needs of the community especially in light of the fact the community has one of the youngest median age (13.2 years) in the United States.

Additionally, although there is a tarmac road traversing through the community, hence easing public transport, other road networks linking vital facilities within the community (e.g., schools, healthcare facilities) are in a deplorable state. There is a police post within the community, but fire services are non-existent. There are many open spaces available in the community that children normally use to play; however, these open spaces have not been well maintained and therefore cannot pass as recreational facilities or parks. There is a main synagogue in the community and several other temples that show the predominantly Jewish religious orientation within the area.

Summary of Key Community Issues

From the narration, it is clear that poverty is one of the main issues that negatively influence effective healthcare delivery within the community. Available data shows that the area has one of the lowest per capita incomes in the United States, and hence it is clear why there are only two public health facilities and one private hospital to provide services to over 18,300 people. The high poverty level in the area needs to be addressed for people to leverage better access to healthcare services.

The other issue that needs to be addressed immediately is the high population growth within the community. This issue has been demonstrated by large families living in multi-family dwellings in the area, and also by overcrowding of schools and other social amenities owing to the fact that a considerable proportion of the population is made up of young people. Religion may also have a role to play in fueling the high population rate. The task for community nurses, therefore, is to come up with strategies that could be used to encourage community members to plan their families.

The purpose of the musculoskeletal system is indeed movement of the body. However, it should also be noted that no less important part of its functionality is maintaining the stability of the body. This is essential because the quality of life is significantly damaged when a person experiences a musculoskeletal ailment. Such conditions are especially dangerous because they can have long-lasting adversarial effects. Whether caused by inflammatory diseases or injuries, musculoskeletal functions can be severely restricted, which may manifest in limited motion ability, joint pain, and fatigue (Holavanahalli et al., 2016). In any event, as it was mentioned, people with musculoskeletal issues require psychological reinforcement for alleviating their depressed mood.

A critical function of the endocrine system is the release of hormones, which control most chemical processes in the organism. It is true that disruption of the endocrine system can lead to altering metabolism and other health problems. However, it should also be mentioned that hormones are particularly vulnerable to man-made chemicals. Many materials contain endocrine-disrupting chemicals, which have adversarial effects, such as abnormal growth patterns (Monneret, 2017). Therefore, in order to avoid endocrine diseases, chemicals should be treated with caution.

In relation to sepsis, it was not strongly enough accentuated how easy this condition can evolve. Anything can serve as the trigger, from infection to damaged skin. It was not noted that sepsis itself is not contagious, meaning that patients can be safely approached and communicated with by their friends and relatives. Sepsis can be identified with a quickly deteriorating condition, high heart rate, and extreme discomfort. As it is stated, testing should be done as quickly as possible because sepsis is a life-threatening emergency.

It should have been noted that osteoporosis is a deceptive disease. The complexity in its identification revolves around the absence of any evident symptoms until the bone fracture. Bone weakening is a natural process that occurs with aging, which means that it will likely affect every old person at some point. However, this does not necessarily mean the development of bone-related diseases (Tu et al., 2018). Osteoporosis is rather a consequence of years of the continuous deficit of minerals.

Although there are numerous risk factors listed, it might be helpful to mention the most common causes. First, there are two types of osteoporosis  primary and secondary ones. Primary osteoporosis is caused by the deficiency of testosterone in men and estrogen in women (Tu et al., 2018). At the same time, secondary osteoporosis is a continuation of a clinical conditions related to the imbalance of calcium, vitamin D, and sex hormones (Tu et al., 2018, p. 93). The difference between the two types is that the first one is associated with aging and the second one is reversible.

It can be summarized that patients with osteoporosis deal with mental pressure and require lifestyle changes. Patients should be aware that stress is an exacerbating factor, which complicates the treatment of osteoporosis (Kelly et al., 2019). Aside from the necessary support from friends and family, patients should adopt healthy habits by consuming supplements strengthening bones, such as calcium and phosphorous. It is important to note that maintaining consistency in healthy eating, exercise, and stress-lifting communication with family and friends is essential in preventing and treating osteoporosis.

References

Holavanahalli, R. K., Helm, P. A., & Kowalske, K. J. (2016). Long-term outcomes in patients surviving large burns: the musculoskeletal system. Journal of Burn Care & Research, 37(4), 243-254.

Kelly, R. R., McDonald, L. T., Jensen, N. R., Sidles, S. J., & LaRue, A. C. (2019). Impacts of psychological stress on osteoporosis: Clinical implications and treatment interactions. Frontiers in Psychiatry, 10(200), 1-21.

Monneret, C. (2017). What is an endocrine disruptor?. Comptes Rendus Biologies, 340(9-10), 403-405.

Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., Van, K., & Hyun, D. (2018). Osteoporosis: A review of treatment options. Pharmacy and Therapeutics, 43(2), 92.