Kurt Lewin developed the theory of change in patient care. The theory includes three main categories: driving forces, constraints, and balance or balance that is achieved as a result (Barto, 2019). This model includes actions such as defrosting, changing and subsequent freezing. Another approach in this paper will be the McKinsey 7S Model. Structurally, both theories are pretty similar. However, they are combined in a core that establishes a certain balance, with the difference that McKinsey has driving forces instead of: style, strategy, people, systems, skills, and structure. With the help of this model, as a rule, more complex structures are assessed, such as an entire medical organization. However, using this model within the framework of one specific case may be promising in patient care.
The first model involves finding a solution in two ways: how to contain negative impacts and improve positive ones. The McKinsey 7S Model, in turn, evaluates the organizational design of the company as a whole. However, if it is applied to more specific cases, one can get a more complete picture of the results. Evidence-based interventions are treatments that are based on positive assessments when done with diligence. The most popular is the Kurt Lewin model, but my mentor applied McKinseys theory to the case of patient care. This relatively new approach allows looking at patient care from a new, unexpected side. This model most clearly identifies the action plan, the available human and other resources to solve the problem, and defines the complete action plan, including its strategy and structure (Perveen & Habib, 2017). A more complete picture will make it possible to use this model in practice more successfully.
References
Barto, D. (2019). Nurse-driven protocols. Nursing2020 Critical Care, 14(4), 18-24.
Perveen, S., & Habib, S. S. (2017). Identifying constraints for hospital infection control management via Mckinsey 7s framework in Pakistan. Pakistan Journal of Public Health, 7(4), 213-222.
The Structure of Enzymes and Their Role in Metabolic Functions
Enzymes were discovered by the German chemist Eduard Buchner towards the end of the nineteenth century. The word enzyme was coined from the active ingredient of the yeast juice that promotes fermentation. Enzymes are organic catalysts that speed up chemical reactions in organisms. In the absence of enzymes, reactions in cells would be very slow (Roberts 1974, p.88). Each reaction is catalyzed by a specific enzyme. Enzymes are classified into two main groups: intracellular and extracellular. Intracellular enzymes are found inside cells. Their work is to control metabolism. On the other hand, extracellular enzymes are produced in the cells. They undertake functions elsewhere inside the organism.
Enzymes are named by attaching the suffix ase to the name of the substrate on which it acts. For example, Maltase acts on maltose, lipase on lipids, and urease on urea. Enzymes are grouped according to the type of reaction they catalyze. For instance, transferases are the enzymes involved in the transfer of atoms. On the other hand, dehydrogenases catalyze the removal of hydrogen atoms from a substrate, while oxidases catalyze the addition of oxygen to hydrogen atoms (Fox 2011). Others include phosphokinases, isomerases, dehydrases, and deaminases. Enzymes work very rapidly, and they are not destroyed by the reactions that they catalyze. Enzymes can also work in either direction, are inactivated by excessive heat, and are sensitive to PH (Grisham & Garrett 1999). Moreover, enzymes are specific in the reactions that they catalyze. Enzymes have a unique structure and they play an important role in metabolic functions.
Enzymes are protein in nature and as such, they exhibit the characteristics of proteins. Like proteins, enzymes are composed of amino acids. The structures formed are enzymes and they have areas of magnetic and electrical charge that are usually in motion (Fox 2011). These pockets are referred to as active sites and this is where a substrate binds.
Like proteins, enzymes have a particular shape. The active site of an enzyme molecule has a distinctive configuration into which only certain specific substrate molecules fit. This specificity is commonly referred to as the lock and key hypothesis which was proposed by Emil Fischer in the late 19th century (Roberts 1974, p. 91). In this hypothesis, the substrate is represented by a padlock and the enzyme is represented by the key. Just like a specific key opens a specific lock, in the same way, a specific substrate acts on a specific enzyme. When too much heat is applied to an enzyme, it becomes denatured, changes shape and prevents the substrates from fitting into the active site.
Energy in living things is generated in a series of chemical reactions. These reactions are referred to as metabolism or respiration. They may be constructive (anabolism) or destructive (catabolism). Energy exchange centers on the transfer of electrons. When electrons are removed from a substance, it is said to be oxidized and when they are added to atoms, these atoms are said to be reduced (Grisham & Garrett 1999). The cellular work necessary for life depends on such electron exchanges and enzymes are a big player in the rate of that process.
Enzymes play a big role in metabolic functions. In order for two molecules to form a compound, they have to collide, resulting in a reaction. The concentration of the substrate molecules, the temperature and the presence of a catalyst influence the collision (Roberts 1974, p. 87). Catalysts found in living things are called enzymes. During reactions, energy barriers may occur. They may be caused by repulsive forces acting between the interacting molecules. The function of an enzyme is to lower the energy barrier to a chemical reaction. It does not affect the course of the reaction or the products of the reaction or the total energy change involved.
Enzymes associate themselves reversibly with the materials on which they act (substrates). They form a unit known as the enzyme-substrate complex. During this interaction, the substrate is activated, subjected to molecular strain or altered. This leads to a smooth reaction path and the formation of end products in a rapid manner (Fox 2011). When the reaction is complete, the substrate remains unchanged and continues to activate other reactions. They are used over and over until inactivation occurs. Not only do enzymes speed up metabolic reactions, but they also control them. In higher vertebrates, digestive enzymes are produced in glands and also in the wall of the gut. Once absorption is achieved the liver performs the job of storing food materials. The digestive enzymes are known as carbohydrates or glycosidases, lipases and esterases and proteinases.
Enzymes play a part in the production of energy from food. Carbohydrates in food are utilized in the cell as monosaccharides, proteins as amino acids and fats as fatty acids. The metabolism of these foods happens in many different ways. Through a series of reactions, monosaccharides, fats and amino acids are oxidized to acetic acid. Acetic acid combined with coenzyme A enters an enzymatic pool (Hoar 1973). Enzymes ensure that hydrogen is generated for the reduction of gaseous oxygen and the production of Adenosine Triphosphate (ATP) chemical energy. ATP is a nucleotide consisting of a complex organic molecule, adenosine, to which a chain of three phosphate groups is attached. The importance of ATP is that when the terminal phosphate group is broken off, a large amount of energy is released. This phosphate is broken off in the presence of an enzyme known as ATPase.
ATP is found in all cells and it is important to always have a ready supply of it. This means that a reverse of the reaction mentioned above should take place whenever energy needs to be stored. The energy required for this reaction comes from sugars. One of the processes in obtaining energy involves the removal of hydrogen atoms. Dehydrogenation is important in ATP synthesis and is achieved under the influence of a dehydrogenase enzyme.
In fat metabolism, enzymes are involved in different stages. Neutral fats form the main source of lipid energy. These are often esters of glycerol and are long-chain fatty acids with an even number of carbon atoms. Many cells contain lipolytic enzymes which hydrolyze these triglycerides into fatty acids and glycerol (Hoar 1973). This is the first step in their metabolism.
Enzymes play a major role in amino acid metabolism. Amino acids result from the digestion of proteins. During starvation, the body runs out of reserves of fats and this results in the breakdown of amino acids. Before being used as energy, amino acids must undergo deamination. This is the removal of nitrogen from amino acids by splitting off of amino groups. A family of enzymes known as amino acid oxidases catalyzes these oxidative deamination reactions (Hoar 1973, p. 229). There are other deamination methods that are not oxidative. Enzymes involved in non-oxidative reactions are associated with certain specific amino acids such as the hydroxyl amino acids (dehydrases), the sulfur-containing amino acids (desulfhydrases), histidine (histidase), and tryptophan (tryptophanase) among others (Hoar 1973, p. 229).
Reactions in the metabolic pathway have a limit at which they should be stopped. Enzyme inhibitors exist for purpose of slowing down or stopping enzyme-controlled reactions. Inhibitors may be competitive or non-competitive. Competitive inhibitors compete with substrates by binding in enzyme active sites. Non-competitive inhibitors bind to the enzyme permanently preventing the substrate from binding. The end-product in metabolism also acts as an inhibitor when it is in excess. It does this by combining with the enzyme responsible for its production in a process known as negative feedback (Roberts 1971, p. 92).
Current experimental techniques utilize enzymes. Enzymes are essential in the making of 3c assays. 3c refers to chromosome conformation capture. This is a technology that allows in vivo genomic organization to be explored. It is normally done to understand the folding of the genome at a big scale in mammals (Hagege et al. 2007). Enzymes are applied in one of the essential steps in the 3c and 4c processes. In the first step, chromatin segments are cross-linked by formaldehyde treatment. In the second step, DNA is digested by an appropriate restriction enzyme (Hagege et al 2007).
Enzymes are essential in life. They speed up chemical reactions in organisms. They catalyze the formation of ATP which is the energy that drives many biological processes. ATP is important in muscle contraction, nerve transmission, synthesis of many materials, the luminescence of fireflies and others. They assist in the breakdown of fats and carbohydrates in order to sustain cell function. They also catalyze the breakdown of amino acids in times of starvation. Although enzymes are easily denatured, their speed makes them more efficient than any inorganic catalysts.
Experiment
This is an experiment to investigate the effects of the variable, temperature on the enzyme catalase.
Hypothesis: Optimum temperature is essential for enzyme function
Materials and equipment
8 Beakers, 6 small and 2 large and a hot plate
750 mL of Hydrogen peroxide
3 pieces of 35g of animal liver
Water and ice
A thermometer
Procedure
This will be carried out in three experiments. Before beginning the experiments ensure that there is no observable change in the hydrogen peroxide. This will be the control. In the first experiment, Drop one piece of liver into a beaker containing 250mL of hydrogen peroxide. After 3 minutes, observe any changes and record your findings. In the second experiment, heat some water on the hot plate using the big beaker. When the water reaches 55°C places one piece of liver in a small beaker and put it in the water bath for five minutes. Remove the liver and drop it into a 250mL beaker of hydrogen peroxide. After 3 minutes, observe any changes and record your findings. In the third experiment, place some ice in a large beaker and let it melt to reach 5°c. In a small beaker, place a piece of liver and put the beaker in the larger beaker. After five minutes, remove the small beaker. Drop the piece of liver into a beaker containing 250mL of hydrogen peroxide. After 3 minutes, observe any changes and record your findings.
Results
At the beginning of the experiment, there was no observable change in the hydrogen peroxide. In the first experiment, once the liver had been added, fizzing occurred rising to the top of the beaker and spilling over. In the second experiment when the liver was added, there was very little fizzing. In the third experiment when the liver was added, there was very little reaction and hardly any fizzing was observed. Observations made are shown below
Temperature
Fizzing
25°c
A lot of fizzing
55°c
Little fizzing
5°c
Little fizzing
Discussion
The liver was used because it plays a central role in metabolic reactions. It contains a lot of enzymes one of which is catalase. Catalase is one of the fastest-acting enzymes known (Roberts 1974). Its presence in hydrogen peroxide breaks it down resulting in the release of oxygen. The fizzing is evidence of oxygen being released.
Results of this experiment showed that temperature affects enzymes. It is supported by other experiments that show the action of enzymes in different temperatures. Enzymes are proteins and excessive heat denatures them and renders them useless. At about 50°C, the rate of an enzyme controlled reaction is high but above this temperature, the rate begins to reduce and at about 60°, it ceases completely (Roberts 1974). This is why the temperature used in this experiment was 55°C. With low temperatures, the reaction rate is too slow and that is the reason why there was minimal fizzing. The rate of reaction reduces significantly as shown in the third experiment when the catalase was unable to break down hydrogen peroxide normally.
Conclusion
This experiment supports the hypothesis that optimum temperature is the best in enzyme reactions. However, the presence of organisms in extremely cold or hot environments does not strengthen the hypothesis stated. There is the need therefore to carry out experiments to determine if the mechanisms of the enzymes involved are heat resistant or if the organisms are able to regulate their own body temperatures.
Reference List
Bairoch A. (2000). The enzyme database in 2000. Nucleic Acids Res, 28(1), 304-5
Fox, M 2011, Explain the role of enzymes in chemical reactions and metabolic pathways. Web.
Grisham, C M., & Garrett, R. G 1999, Biochemistry, Saunders College, Philadelphia.
Hagege, H., Klous, P., Braem, C., Splinter, C., Dekker, J., Cathala, G., Laat, W., and
Forne, T. 2007, Quantitative analysis of chromosome capture assays (3c-qPCR). Nature Protocols.2(7):1722-1733. Web.
Hoar, WG 1973, General and comparative physiology, Prentice-Hall, London. Intermolecular bonding. Web.
Jaeger K. E., & Eggert, T. (2004). Enantioselective biocatalysis optimized by directed evolution. Curr Opin Biotechnol. 15 (4), 30513.
Roberts, MBV1974, Biology: a functional approach, Thomas Nelson & Sons Ltd, London.
The primary function of the emergency management team is to prepare beneficial arrangements and protocols as a response to specific emergencies and other natural disasters. They are also helpful after emergencies because they coordinate with government agencies and other elected officials to reduce harmful effects. Some organizations have qualified to emergency team whereas other organizations have not. Those organizations with a well-trained team provide quality services during emergencies.
The organizations should organize free training of their members free emergency management skills so as to encourage more members to be trained. Most of the nurses fear the high costs incurred during the training process. Because the exercise is cheap and readily available, most of them will come out to be trained. Organizations should organize meetings with the members of different departments to encourage them to acquire skills in emergency management (Yang et al., 2020). Therefore, more will be motivated through these seminars and hence get eager to be trained. Also, through varied training methods such as movie watching and simulation exercises, most organizations are likely to encourage more nurses to be trained in emergency management instead of using a single form. Finally, the scientific research based on disaster nursing should be strengthened to encourage more nurses to carry out disaster and emergency management.
The skills gained in emergency management training are essential because the lessons prepare one to follow the emergency procedures which are set. Since the protocols are made to reduce the physical injuries that one might have incurred, the experience thereof provides one with the necessary skills to handle the emergency as required compared to a person without the skills. Through the skills obtained, the prevention of fatalities and injuries has become more accessible during emergency management, unlike when the skills are not known.
According to Dehler, Zessin, Bartsch, and Mairbaurl (2006), cardiac pulmonary edema also known as congestive cardiac failure (CCF) or congestive heart failure (CHF) occurs in alveolar hypoxia pathological because of an increase in pulmonary capillary pressure. Cardiac pulmonary edema is directly linked to high capillary pressure by alveolar fluid reabsorption, disruption of endothelial barrier function, alveolar epithelial permeability, reduction in plasma oncotic pressure, and increases in lung vascular endothelial and transmicrovascular filtration mechanisms (Diseases and Conditions Pulmonary Edema, 2014). Dehler, Zessin, Bartsch, and Mairbaurl (2006) argue that the asymmetry of cardiac efficiency leads to ejection fraction with a low volume of blood or the hearts failure to pump sufficient blood, which comes from the lungs. The resulting increase in pressure in the left atrium and vein capillaries (cardiac myocytes) causes blood to engorge into the veins and the tissues leading to the swelling of the feet and legs (Dehler, Zessin, Bartsch & Mairbaurl, 2006). In summary, the direct causes of CHF include heart failure, intrapulmonary pressure (cardiac preload) in the pulmonary artery at the diastole just before systole, and chronic lung diseases, which lead to increases in interstitial fluids or extravascular lung water.
The medical condition resulting in CHF includes coronary heart disease which is caused by the accumulation of plaque and the consequent heart attack. Cardiomyopathy is another factor that causes edema, which is a result of damaged heart muscles and heart valve problems (Dehler, Zessin, Bartsch & Mairbaurl, 2006).
Essential hypertension is another risk factor that causes edema. Clinical trials show that when high blood pressure remains uncontrolled, it causes the thickening of the left ventricular muscle, which is the direct cause of coronary artery disease or idiopathic cardiomyopathy. The symptoms of hypertension include shortness of breath swollen feet, fatigue, sudden death, and frequent coughing. Essential hypertension, which is associated with transmicrovascular, remains elevated because of the transcapillary escape of proteins (Diseases and Conditions Pulmonary Edema, 2014). The presence of efferent (postglomerular) arteriolar resistance causes the transmission of oncotic pressure, which decreases peritubular capillary pressure. The resistance of both ultrafiltration coefficient and renal plasma flow underpins the increase in glomerular capillary pressure. A high heart rate combined with high stroke volume leads to cardiac output and high peripheral resistance of essential hypertension.
According to Diseases and Conditions Pulmonary Edema (2014), non-cardiac pulmonary is another direct cause of edema, which is directly linked to heart disease in elderly people (Diseases and Conditions Pulmonary Edema, 2014). Investigations show that an increase in the permeability of vascular endothelium, pulmonary vascular resistance and pressure, interstitial and alveolar edema fluid high in protein content (inflammatory cytokines and leukocytes in bronchoalveolar lavage), fluid leakages in the pulmonary arterial walls (endothelial permeability), damaged capillary walls and peripheral arteries, and over perfumed to be the direct causes of heart failure (Dehler, Zessin, Bartsch & Mairbaurl, 2006). Other causes include acute respiratory distress syndrome (hypoxia) as a result of high altitudes. Clinical investigations show that increases in edema and protein leaks are directly caused by a combination of hypoxia and viral infections of the tract (Dehler, Zessin, Bartsch & Mairbaurl, 2006).
In conclusion, the syntheses of the differences between the three causes of edema provide an excellent basis for further research in controlling the disease.
References
Dehler, M., Zessin, E., Bartsch, P. & Mairbaurl, H(2006) Hypoxia causes permeability oedema in the constant-pressure perfused rat. European respiratory journal, 27(3), 1-7.
Health policies represent a robust field for research since they reflect the current state of health management, at the same time providing an insight into key community issues and the overall state of healthcare efficacy. Moreover, the assessment of the existing legislation on health issues provides insights into the further development of public health management strategies (Shi, 2014a). However, most importantly, the evaluation and study of health policies lead to an increase in access to health services for vulnerable populations (Fawole, Srivastava, & Feemster, 2019). For health administrators, the assessment of health policies allows updating the current framework for health management, introducing new access options for disadvantaged groups, and improving health outcomes in the target demographic.
Studying health policies allows determining how well they represent the current health issues and the needs of vulnerable groups. Therefore, as a health administrator, one must keep track of policy trends and debates. The described strategy allows one as a health administrator o identify vital threats to the well-being of target groups, thus improving health outcomes and providing services of better quality (Liu, Wang, Ding, Chen, & Wang, 2020). Moreover, as a health administrator, one can provide insight into current health issues that have to be taken into account when shaping health policies. As a result, the efficacy of new health regulations will rise due to the input provided by a health administrator (Shi, 2014c). Specifically, Shi (2014b) explains that the involvement of a health administrator may shape health insurance policies, making insurance more affordable to disadvantaged groups. Thus, for a health administrator, it is critical to study the existing health policies, as well as participate in shaping new ones. Finally, the dialogue with a health administrator will help policymakers to establish an improved connection with the target population, thus learning about their needs, receiving feedback, and shaping policies accordingly.
Shi, L. (2014a). Federal health policymaking. In Introduction to health policy (pp. 31-52). Health Administration Press.
Shi, L. (2014b). Health policymaking at the state and local levels and in the private sector. In Introduction to health policy (pp. 53-73). Health Administration Press.
Shi, L. (2014c). Overview of health policy. In Introduction to health policy (pp. 3-27). Health Administration Press.
Analyzing the frequency of interactions between physicians and pregnant women is essential for assessing the level of care patients receive from their healthcare providers. The information that has to be collected includes medical records, commentary from patients, and commentary from physicians. This data is vital in illustrating how often and how much time physicians tend to spend with pregnant women during checkups and various treatments. In case the data shows a low rate of frequency and too short patient-physician interactions, doctors will be able to acknowledge the problem and make certain changes that will benefit the medical facility. The study focuses on the experiences of patients and the overview of the providers, which ensures an unbiased conclusion and a possible plan that would lead to benefits in the field of medical care.
Key Study Components
Data Collection PlanImplementing a data collection plan regarding the frequency of interactions between physicians and pregnant women will suggest possible changes that need to be done for better care provision. The data will be collected from medical files, interviews with patients, and interviews with physicians, which will allow for a clear understanding of the current situation and a possible plan of improvement.
Data Security PlanAll the gathered raw data and the patients and physicians personal information will be stored on a platform that requires authentification and authorization since the report will contain medical records, names, and personal details. Therefore, only the designated researchers and other people who are actively contributing to the study will be able to access it by using individual passwords to avoid specific security issues that may compromise the ethical aspect of the study.
Benchmarking PlanThe finished research and the findings illustrated after data analysis will be published online in medical journals, which will ensure a favorable health information exchange between specialists and medical institutions. Using adequate terminology, organizing the information in an accessible way, and implementing common identifiers in the text will ensure standardized information based on the notion of interoperability.
Quality and Change Management StrategiesCommunication with both the patients and the physicians is one of the quality and change management strategies in the medical field, which is the critical point of the research. Transparency is another policy highlighted by the personal interviews and honest feedback from both patients and providers regarding the frequency of their interactions, as well as transparency from the researchers during the interviews.
Conclusion
It is crucial to research the frequency of interactions between physicians and pregnant women to ensure an adequate level of care and future implementations that may have a favorable outcome for the medical facility. This will not only allow to improve patient satisfaction but also examine the physicians opinion on the subject matter, which is essential for approaching the subject from both sides. Lack of patient-doctor interactions may be an effect of specific issues, such as lack of trust towards the physicians, limited time for checkups, and burnout that makes the provider less interested in having follow-up meetings. According to researchers, the physicians burnout may lead to an unfavorable patient-doctor relationship (Mathur & VanderWeele, 2020). Suppose the study illustrates the lack of such interactions. In that case, medical health providers will improve on this level and start having more checkups and meetings with pregnant women in need of advice from a specialist. This will lead to fewer pregnancy-related health issues that may occur, a better patient experience, and an overall closer relationship between pregnant women and their doctors, resulting in more frequent checkups.
Providing assistance to the milk bank is an essential condition for donor help that vulnerable recipients need. At the same time, not every woman can become a donor since the verification and preparation procedure requires a preliminary assessment of about one to two weeks. In addition, the number of people willing to provide assistance may be high, which can also delay the response to potential donors.
Donor Screening Requirements
The screening process for donated milk is costly, and one of the requirements for potential donors is to donate 75 ounces as an initial donation. One of the important conditions is adherence to the criteria necessary to cooperate with the milk bank on an ongoing basis. In case of questions regarding the possibility of becoming a donor, the attached form will help give answers to the main ones.
The conditions that should be observed to become a milk donor are as follows:
Good health indicators and the presence of a child up to one and a half years old.
Expressing consistently is imperative to supply enough breast milk. The minimum volume the milk bank requires is approximately 150 ounces over a given period, which helps cover the cost of expensive screening procedures.
The loss of a child is not a reason for refusing to cooperate, and in case of proper storage conditions, donated milk is taken regularly.
A blood test is a necessary procedure to identify potential health problems.
The use of chemicals that promote the production of additional milk is prohibited. The list of drugs approved for taking in case of donation includes hormonal and contraceptive medications, as well as vitamin complexes.
Canadian residence.
Fluency in English.
An opportunity to deliver expressed milk to a specific hospital or collection depot.
Reasons for Refusal
Despite the absence of problems with breastfeeding, some limiting factors can be the reasons for the refusal to donate milk:
The continuous use of medications that promote milk production, as well as antidepressants.
Smoking.
Positive results for HIV status, syphilis, hepatitis B and C, and Human T-lymphotropic Virus.
The increased risk of HIV infection, for instance, a partners positive status.
The child is over one and a half years old.
The experience of living in individual countries (a detailed list can be provided on request).
Drug use experience over the past five years.
Screening Procedure
The first contact with a potential donor can take place both in-person and by phone. In case of consent to the conditions described by a medical provider, a woman receives the necessary documents by mail or e-mail. This list includes consent for milk donation, medical history as reported by the potential donor, and consent for basic screening procedures, including donating blood. After receiving the forms back, the provider needs time to review them and send the referrals for analysis. After the tests for the absence of prohibited diseases are made, they are sent to the provider back, and in the near future, the woman receives an invitation to donate milk.
Questions During Screening
The main questions to ask a potential milk donor are as follows:
Have you encountered a refusal to donate blood for health reasons?
In the past year, have you had blood or organ transplant surgery, body piercing, subcutaneous injections, acupuncture, or electrolysis?
Have you had any health problems requiring the adoption of pituitary growth hormone or a meninges transplant?
Have you had any type of hepatitis in the past year or have you had contact with such a patient?
Have you had intimate contact with anyone with Creutzfeldt-Jacob disease?
In the past year, have you or your partner had contact with HIV-positive patients or patients with Human T-lymphotropic Virus or hemophilia?
Are there herbal supplements or herbal vitamins in your diet?
Have you had cancer or tuberculosis in the past five years?
Procedures of Collecting and Storing Donated Milk
The following list of recommendations is a valuable guideline that can help make expressed milk safe for donation:
This is best to express milk at the same time of day. This will contribute to minimizing the impact on well-being and optimizing the babys feeding cycles.
Cleanliness is essential; therefore, this is critical for a donor to wash ones hands thoroughly and dry them with a paper towel before expressing.
If special equipment is used for expressing but not a method by hand, for instance, a special pump, individual safety rules are to be taken into account:
The pump parts need to be thoroughly rinsed in hot soapy water and rinsed off the parts with hot water.
Complete drying is important; in this case, one can either allow the pump parts to air dry or use a paper towel. This is essential to store the device safely, for example, in a sealed bag in the refrigerator.
The component parts of the device need to be disinfected regularly (at least once a day). Boiling is a traditional and convenient method, but washing on the top shelf of the dishwasher is also possible.
After milk has been expressed, this is crucial to use an adequate rapid cooling method to prevent spoilage. One of the following approaches can be used for this purpose:
As a storage container, plastic bottles with lids may be utilized, which have been pre-washed and dried in accordance with the above scheme.
Special sterile storage bags can be applied for donors convenience. They are commercially available online and are suitable for quickly cooling expressed milk.
Glass bottles with lids may be used, but the procedure for washing and drying them should be exactly the same as in the aforementioned instructions.
This is strictly forbidden to touch a clean container and its lids with dirty hands, both inside and outside. When expressing, the same container cannot be reused even if it is not visually contaminated. In addition, only one container may be utilized used at a time. This means that one cannot add new milk to an already filled container.
To prevent damage to the container and milk, one should not fill the entire space in it. When frozen, the liquid tends to expand, and space (about one inch) is critical.
All donated containers will not be returned in any form.
To identify oneself, personal information should be applied to the container. With the help of a permanent marker, a donor should write one name, the date of expression, its time, and the volume received. For this purpose, one should not apply the inscription directly to the container but rather use adhesive tape.
Expressed milk is taken frozen, and this is best to place the container at the back of the freezer to maintain a stable, low storage temperature and prevent defrosting.
Deep freezing keeps breast milk stored for up to 12 months. With standard freezing (temperature about -16oC), this period is reduced to six months. However, the sooner the milk is delivered to the bank, the better since the maximum shelf life of one year may not allow the use of some donor products due to the expiration date.
Fearing for the safety of milk and its storage, donors should not refuse to store it properly. However, when checking in to the bank, a specific question should be written on the container, which seems relevant and can help optimize the storage procedure. Moreover, any health changes need to be reported to the banks employees immediately. This also includes risk factors, such as contacts with patients with dangerous illnesses. Individual restrictions apply to expressing: if within 12 hours, a donor has consumed alcohol or medications, including those on an herbal basis, this is more reasonable to refuse to express for a while.
Special safety regulations have to be observed in a number of cases. For professional advice, a donor can contact the BC Womens Hospital & Health Center and ask the necessary questions. As individual nuances that require consultation, one should take into account the following ones:
The illness of the child or anyone in the family since it may be directly related to the quality of breast milk.
The appearance of a dangerous fungal infection on the nipples, mastitis, or a heavy blister. In addition, if the child develops thrush, this is also a reason to seek a recommendation.
A donor has been vaccinated against any of the viral diseases.
A donor or a partner has got a tattoo or noticed changes in the skin.
Other questions can also be asked by the BC Womens Hospital & Health Center at 604-875-2282.
Until a donor receives answers to ones desired questions, they should not stop expressing milk. Despite a potential pathology and health problems, this procedure will maintain the level of expressed milk in the same volume as before. In addition, it will prevent the development of associated risks that might damage the breast; therefore, the pumping regimen needs to be maintained at the same level to avoid even more discomfort.
Delivery Procedure
The mode of expressed milk delivery can be either individual or through a courier. When deciding on self-delivery, donors should inform the Provincial Milk Bank of their intention in advance to agree on a date and time. In case courier services are required, as a rule, the bank will not be able to reimburse the cost of these services. However, conditions may vary from area to area in British Columbia. Therefore, to cover the cost of courier delivery, may contact several milk banks to find out which of them can reimburse delivery costs, thereby selecting an optimal variant.
Milk Banks Information
Preliminary contact with the milk bank is obligatory to agree on the time and place of delivery of expressed milk. Below is a list of banks, including their opening hours, addresses, and telephone numbers. By using this information, donors will be able to find the best place for themselves to interact and provide valuable assistance to vulnerable recipients, thereby making a significant contribution to the countrys healthcare.
Fraser Health Abbotsford Health Unit: (604) 864-3400 104-34194 Marshall Rd. Abbotsford Drop-off hours: 9:30 to 3:30 Monday to Friday. Closed weekends and Stat holidays. Park in a spot marked Fraser Health permit parking . Note license plate number and register at front desk.
Agassiz Health Unit: (604) 793-7160 7243 Pioneer Ave, Agassiz Drop-off hours: 8:30 to 4:00 Closed for lunch 12:00-1:00 Closed weekends and Stat holidays.
Burnaby Health Unit: (604) 918-7605 300-4946 Canada Way, Burnaby Drop-off hours: 8:30 to 4:00 Monday to Friday. Closed weekends and Stat holidays. Free parking in back of the building marked Visitor Fraser Health or street parking.
Chilliwack Health Unit: (604) 575-5100 45470 Melholm Rd, Chilliwack Drop-off hours: 830 to 4:00 Monday to Friday Closed weekends and Stat holidays. Free street parking (hard to find), or pay parking on side lot (meter is at front of building).
Cloverdale Health Unit: (604) 575-5100 205-17700 56 Ave, Cloverdale Drop-off hours: 8:30 to 4:30 Monday to Friday *by appointment on Weekends and Stat holidays Free parking located in strip mall at 177B and Hwy 10
Delta North Health Unit: (604) 507-5400 11245 84 Ave, Delta Drop-off hours: 8:30 to 4:30 Monday to Friday Closed weekends and Stat holidays. Free parking on site enter driveway from 112 Street (Library on corner) Delta South Health Unit: (604) 952-3550 (switchboard ask for South Delta Public Health Unit) 4470 Clarence Taylor Cres, Delta (Ladner) Drop-off hours: 8:30 to 4:30 Monday to Friday Closed weekends and Stat holidays. Limited parking but available on-site closest to front door.
Guildford Health Unit: (604) 587-4750 100-10233 153 Street, Surrey Drop-off hours: 8:30 to 4:30 Monday to Friday Closed weekends and Stat holidays. Free Street parking.
Hope Health Unit: (604) 860-7630 44 Park Street, Hope Drop-off hours: 8:00 to 4:00 Monday to Friday Closed weekends and Stat holidays. On-site parking.
Langley Health Unit: (604) 539-2900 20389 Fraser Highway, Langley Drop-off hours: 8:00 to 4:30 Monday to Friday Closed weekends and Stat holidays. Free parking.
Maple Ridge Health Unit: (604) 476-7000 400-22470 Dewdney Trunk Rd, Maple Ridge Drop-off hours: 8:30 to 4:30 Monday to Friday Closed weekends and Stat holidays. Underground parking first hour free but ticket required from meter
Mission Health Unit: (604) 814-5500 7298 Hurd Street, Mission First Floor Drop-off hours: 8:30 to 4:00 Monday to Friday as pre-arranged by phone call with Mission Public Health Nurse Closed weekends and Stat holidays. Free parking in lot beside building near Mission Memorial Hospital laboratory parking
Newport Health Unit: (604) 949-7200 200-205 Newport Drive, Port Moody Tri-Cities Public Health (Coquitlam, Port Coquitlam, Port Moody) Drop-off: Please call ahead for arrangements Closed weekends and Stat holidays. 2-hour street parking available at Newport Village or underground parking across street Browns Restaurant
Newton Health Unit: (604) 592-2000 7337 137 Street, Surrey Drop-off: 8:30 to 4:15 Monday to Friday Closed weekends and Stat holidays. Free parking on-site.
New Westminster Health Unit: (604) 777-6740 218-610 6th Street, New Westminster Drop-off: 1:00 to 4:00 Monday to Friday unless otherwise arranged by phone Closed weekends and Stat holidays. Above BMO, underground parking available from Princess Street or at corner of 6 Ave & 7 Street
North Surrey Health Unit: (604) 587-7900 220-10362 King George Boulevard, Surrey Drop-off: 1:00 to 4:00 Monday to Friday by pre-arranged appointment with North Surrey Breastfeeding Team. Contact: Kathleen Ward-Driscoll 8:30-4:30 (604) 587-7930
White Rock Health Unit: (604) 542-4000 15476 Vine Street, White Rock Drop-off: 9:00 to 4:00 Monday to Friday Closed weekends and Stat holidays. Limited pay parking in front of Berkeley Building. Some street parking and pay parking at Peach Arch Hospital. Island Health
Victoria General Hospital: (250) 727-4212 1 Hospital Way, Victoria Drop-off milk in Neonatal ICU. Please call before coming to hospital. Pay Parking available on site. Northern Health University Hospital of Northern British Columbia
(250) 565-2000 1475 Edmonton Ave, Parkwood Place, Prince George Drop-off milk in Neonatal ICU. Please call before coming to hospital. Pay Parking available on site. Vancouver Coastal Health
BC Womens Hospital: (604) 875-3743 4500 Oak Street, Vancouver Enter off Oak Street between 28th & 32nd Ave, turn right following road to Main Outpatient & Visitors entrance #93 The Milk Bank Reception Desk #1 is located in the main lobby across from the BC Womens Auxilliary Gift Shop. Drop-off hours: 8:00 to 4:00 Monday to Friday. Please call before coming to hospital and for free parking instructions. Closed weekends and Stat holidays.
RavenSong Community Health Centre (604) 709-6400 2450 Ontario Street, Vancouver Drop-off hours: 8:30 to 4:00 Monday to Friday Closed weekends and Stat holidays. Parking in front of building (between 8th & Broadway), upper and lower level.
Evergreen Community Health Centre (604) 872-2511 3425 Crowley Dr, Vancouver Drop-off hours: 8:30 to 4:00 Monday to Friday Closed weekends and Stat holidays. Parking in front of building or north side of Crowley Dr passenger drop-off zone. Near Joyce SkyTrain Station
North Shore Community Health Centre (604) 983-6700 2121 Marine Drive, West Vancouver Drop-off hours: 8:30 to 4:00 Monday to Friday Closed weekends and Stat holidays Free parking available at West Vancouver Community Centre above ground and underground. Vancouver Coastal Health Clinic area off main level hallway.
Richmond Public Health (604) 233-3150 8100 Granville Avenue, Richmond Drop-off hours: 9:00 to 4:00 Monday to Friday Closed weekends and Stat holidays. Use 10-minute Loading Zone parking area. Pay Parking also available.
Squamish Health Unit (604) 892-2293 1140 Hunter Place, Squamish Drop-off hours: 8:30 to 4:00 Monday to Friday Closed weekends and Stat holidays. Call ahead to confirm.
Menstruation is essential because it plays a crucial role in a womens reproductive health. Inadequate knowledge and education are the primary causes of adverse issues associated with menstruation. In this case, I would educate the girls about the importance of hygiene during periods. Genital areas cleanliness reduces infection incidents by up to ninety-seven percent (Unemo et al., 2017). Additionally, using the appropriate sanitary towels reduces menstruation-associated risks. Therefore, pads should be changed after four hours, after which the hands should be washed to maintain hygiene.
An individuals body has an excellent defense mechanism that protects them during menstruation. However, Arora (2017) expounds that inappropriate hygiene can result in fungal or urinary tract infections. This happens when a soiled or dirty cloth remains intact with the body for a lengthy period. The girl experiences untoward reactions, such as friction between the thighs and foul odor. I would explain to the girls that sexually transmitted infections (STIs) occur through sexual contact.
The illness is passed when individuals have unprotected oral, vaginal, or anal sex with an infected person (Unemo et al., 2017). However, using contraceptives such as condoms reduces the risks of contracting STIs. If symptoms such as vaginal bleeding, unusual vaginal discharge, itchiness, rashes, or lumps occur, girls should visit healthcare organizations but not self-medicate (Unemo et al., 2017). Failing to seek medical help can result in long-term adverse effects, including blindness.
Menstruation practices are different between India and the United States because Indian girls experience significant discrimination. These women are prohibited from attending social and religious events and are kept out of the kitchen (Arora, 2017). Additionally, the girls fear speaking to family members but instead talk to teachers or healthcare professionals. In contrast, females in America can openly talk to their parents but avoid informing the boys.
Unemo, M., Bradshaw, C. S., Hocking, J. S., de Vries, H. J., Francis, S. C., Mabey, D., Marrazzo, J. M., Sonder, G. J. B., Schwebke, J. R., Hoornenborg, E., Peeling, R. W., Philip, S.S., Low, N., & Fairley, C. K. (2017). Sexually transmitted infections: Challenges ahead. The Lancet Infectious Diseases, 17(8), e235-e279.
It is hard to deny that a persons life and health are extreme values, but many people fail to maintain good health due to various reasons. Healthcare professionals are ready to help in preventing serious health issues and providing care to those in need. I have been fascinated by the work of physicians who manage to identify the exact problem and solve it by developing treatment plans. Clearly, every healthcare professional contributes to the provision of high-quality services to ensure individuals and public health. However, a physician can be regarded as a frontline figure who accepts the challenge and detects the hidden enemy. Since my childhood, I have had a great interest in the way the human body functions and why people become ill. I remember asking my relatives about their symptoms and diagnosis after they visit a doctor. As I grew older and accumulated some knowledge, I started to give my diagnoses.
Clearly, I am not an innocent child with a doctors kit now, as I have become a well-educated young person who wants to study to be a physician. I have made considerable progress in natural sciences, which makes me equipped with the necessary knowledge regarding the way the human body works. I understand that a persons health depends on the effective operation of complex systems. I am good at analysis, so I will be able to identify the damaged areas to be treated. I believe I will contribute to the development of physician practice as I am eager to explore diverse ways to ensure that a persons physical, psychological, and emotional states are appropriate. I am ready to try evidence-based strategies and develop new treatments that could help diverse populations. Some physicians concentrate on the physical aspect trying to identify the cause of a health issue, but I will use a more comprehensive approach. My ability to consider all relevant details will help me in my practice and my research that will be the basis of my clinical work.
Patients diagnosed with hypotension usually have a low level of water in the body. To solve this problem, it is typical to resort to intravenous fluid resuscitation (Kyriakides et al., 1994). However, it is often unclear when and how much additional fluid is necessary for maintaining cardiac functions. Passive leg raise (PLR) is a maneuver that makes it possible to shift the patients blood from the lower body to the top, which simulates rapid fluid loading thereby increasing stroke volume and improving blood pressure outcomes (Ohashi et al., 1997). This test should be implemented in clinical settings since it allows avoiding hypotension by predicting fluid responsiveness in patients (Teboul, Monnet, & Richard, 2005).
Search Method
To investigate the existing studies on the topic, Google Scholar, National Guideline Clearinghouse, Ovid, CINANL, and Medline were used as the major databases since they contain the biggest number of articles satisfying my search parameters. The keywords I used included: passive leg raise, hypotension, fluid resuscitation, fluid responsiveness, reflex control, and the Trendelenburg position. The criteria for inclusion were the relevance of the topic to the given research, the English language used in the study, and the time period of publication between 1990 and 2005. Articles published earlier than in 1990 and in other languages were excluded from the search. Although the number of results partially meeting the specified parameters exceeded 10.000, 6 studies were selected from the list since they could best support the present research.
Summary of the Studies
Bridges and Jarquin-Valdivia (2005).conducted a review of literature on the use of Trendelenburg position as a way for resuscitation of patients suffering from hypotension. They searched Pubmed online, critical care textbooks, cited bibliographies, and Advanced Cardiac Life Support guidelines. The authors claimed that literature on the topic was scare and unreliable and concluded that the position was not good for hypotensive patients, which speaks in favor of PLR. The major strengths of the study is its extensive coverage (articles from 1964 to 2004). The search was limited by the language of publications and the restricted number of key words.
Kyriakides et al. (1994) evaluated the effects of passive leg raise on cardiovascular performance in 31 patients of 51 ± 10. They obtained two M-mode echocardiographic and continuous wave Doppler studies of aortic flow, the first of which was before and the secondafter the intervention. The preload increased, and it was concluded that PLR improved cardiac performance. The major strength of the study is that is supported by clinical trials while the limitation is a small sample.
Mancia et al. (1991) studied the baroreceptor ability of patients and found out that its fall brings about blood pressure changes. They concluded that cardiopulmonary receptor modulation of vascular resistance was impaired by aging, which accounted for some hemodynamic abnormalities in the advanced age. The strength of the research is that it supports the necessity of intervention in the elderly. Its limitation is the absence of recommendations, which intervention is more suitable.
Pinsky and Payen (2005) investigated hemodynamic monitoring involving therapeutic trials of preload responsiveness. They assessed the effectiveness of several functional measures (indicated by other studies), including change monitoring in central venous pressure during spontaneous inspiration, systolic pressure, variations in arterial pulse pressure, and aortic flow variation as a response to PLR or vena caval collapse during positive pressure ventilation. The authors concluded that these measures could improve blood pressure outcomes. The strength of the study is the comparison of several methods while its limitation is the absence of statistical evidence.
Rebain, Baxter, and McDonough (2002) conducted a systematic review of papers from six computerized bibliographic databases on PLR to assess the procedure, its outcome, and clinical significance. The authors found out that the procedure had no set protocol. Neither was there any consensus of result interpretation. Moreover, it was unclear if a positive or negative outcome of the test was of higher diagnostic value. The strength of the study is that it is supported by extensive evidence. However, it is limited by the aspect of PLR application (by its ability to traction the sciatic nerve).
Rex et al. (2004) conducted a research involving 14 patients after coronary artery bypass grafting, who received mechanical ventilation in pressure-controlled mode. They measured stroke volume index, cardiac index, and intrathoracic blood volume index before and after implementing the Trendelenburg position. They discovered that stroke volume variation (SVV) decreased significantly whereas other indicators increased. It was concluded that the haemodynamic effects of volume loading could be assessed by measuring SVV. The strength of the research is the use of several indicators to evaluate the intervention. Its limitation is a small sample. The result obtained by this study will be compared with the ones of PLR implementation to compare the effectiveness of the interventions.
Conclusion
The majority of the mentioned studies are retrospective and did not involve any intervention. This implies that there is a need in empirical evidence to support the effectiveness of PLR. The strength of the research at hand is its experimental design. Its limitation is that the sample will be restricted to patients of one hospital. Internal validity will be ensured by the research design and the selected variables (blood pressure variations during the intervention). This will guarantee that the change in the dependent variable (blood pressure) will be brought about exclusively by the independent variable (PLR) excluding the effect of extraneous variables. External validity will be ensured by randomization, single intervention, pretesting, and experimental setting. This way, it will be possible to generalize the results and apply them to different clinical settings.
References
Bridges, N., & Jarquin-Valdivia, A. A. (2005). Use of the Trendelenburg position as the resuscitation position: To T or not to T? American Journal of Critical Care, 14(5), 364-368.
Kyriakides, Z. S., Koukoulas, A., Paraskevaidis, I. A., Chrysos, D., Tsiapras, D., Galiotos, C., & Kremastinos, D. T. (1994). Does passive leg raising increase cardiac performance? A study using Doppler echocardiography. International Journal of Cardiology, 44(3), 288-293.
Mancia, G., Cleroux, J., Daffonchio, A., Ferrari, A. U., Giannattasio, C., & Grassi, G. (1991). Reflex control of circulation in the elderly. Cardiovascular Drugs and Therapy, 4(1), 1223-1228.
Ohashi, M., Sato, K., Suzuki, S., Kinoshita, M., Miyagawa, K., Kojima, M., & Dohi, Y. (1997). Doppler echocardiographic evaluation of latent pulmonary hypertension by passive leg raising. Coronary Artery Disease, 8(10), 651-656.
Pinsky, M. R., & Payen, D. (2005). Functional hemodynamic monitoring. Critical Care, 9(6), 566-578.
Rebain, R., Baxter, G. D., & McDonough, S. (2002). A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000). Spine, 27(17), E388-E395.
Rex, S., Brose, S., Metzelder, S., Hüneke, R., Schälte, G., Autschbach, R.,& Buhre, W. (2004). Prediction of fluid responsiveness in patients during cardiac surgery. British Journal of Anaesthesia, 93(6), 782-788.
Teboul, J. L., Monnet, X., & Richard, C. (2005). Arterial pulse pressure variation during positive pressure ventilation and passive leg raising. Functional Hemodynamic Monitoring, 3(2), 331-343.
