The patient was a 66-year-old woman who experienced pain due to the ingrown toenail on the lateral side of the right hallux. It should be noted that onychocryptosis can give rise to several complications such as infection and inflammation (Khunger & Kandhari, 2012, p. 281). These are some of the main risks that could not be overlooked while treating people who have this problem. Moreover, the patients condition was also aggravated by ill-fitting footwear. Researchers note that ill-fitting footwear can significantly increase the effects of onychocryptosis, especially the discomfort of a patient (Khunger & Kandhari, 2012, p. 281). Therefore, the problems faced by this woman were not uncommon. On the whole, this problem requires a medical worker to take several actions to assist the patient.
One should take into account that this condition can significantly impair the health of an individual. First of all, such a person experiences regular discomfort and even pain, especially during walking. Furthermore, ingrown toenails can become more dangerous when a patient has the peripheral vascular disease (Locking-Cusolito et al. 2005, p. 373). In turn, the assessment of the patient indicated that she had some vascular problems in the past. This is why onychocryptosis could have lead to significant complications. This problem is more likely to affect people who are older than fifty. As it has been said before, the risk of infections is also very high in such situations. Moreover, sometimes, surgery can be the only way to treat onychocryptosis, and this option may not be suitable for elderly patients.
Additionally, it is critical to mention other co-morbidities that accompanied onychocryptosis. In particular, my evaluation showed that the patient had bilateral edema, lower limbs cramping, and Hallux abducts Valgus. These problems could not be overlooked because they significantly affected the physical wellbeing of a patient. I had to consider them while developing treatment methods. It was necessary to design interventions that could improve the physical experiences of the patient.
It is vital to speak about the previous history of the patient since this information can be relevant to the case. In particular, it is important to note that the patient had wrist surgery and it was difficult for her to cut her nails. Therefore, one can say that people, who struggle with some disability, are more likely to develop onychocryptosis. This issue is important for developing treatment options and follow-up evaluation.
I took several steps to help the patient. I cut the nails of the patient and explained to her how onychocryptosis can affect the health of afoot. Additionally, I noted that this issue can occur when a person cuts the nails too short because the skin can fold over the nail (Kulkami, 2009, p. 325). People should be aware of this issue to avoid onychocryptosis (Kulkami, 2009, p. 325). In contrast, many individuals forget about personal hygiene. This is one of the reasons why many people have to cope with this problem of ingrown toenails. Furthermore, I needed to debride hyperkeratosis from both feet to improve the experiences of a patient. Furthermore, it was important to use the plantar cover since in this way one can distribute pressure from the first metatarsophalangeal joint (Milankov, Miljkovic, & Popovic 2003). These are the main actions that I had to take. They were important in minimizing the risks of onychocryptosis and improving the physical wellbeing of the patient. In my opinion, these interventions can help a patient avoid many risks in the future.
Apart from that, I can argue that a medical worker should pay close attention to the education of patients. It is important to explain how they can avoid risks to their health. For example, a medical worker can inform people about such aspects as footwear or personal hygiene (Meerabeau, 2011, p. 21). While interacting with my patient, I was able to see the importance of this issue. Provided that a healthcare professional copes with this task, a great number of complications can be avoided. In my presentation of this case, I focused on such aspects as previous medical history, the possible, current condition, and description of the treatment plan. This approach helps to describe medical cases.
Overall, this case shows that onychocryptosis can significantly impair the foot health of a person. Moreover, in many cases, it can be accompanied by other co-morbidities such as Hallux abducts Valgus. Each of these issues should be taken into account by medical workers while helping patients. These are some of the main issues that can be identified. These are the tasks that a medical practitioner should consider.
Reference List
Khunger, N., & Kandhari, R. (2012). Ingrown toenails. Indian Journal Of Dermatology, Venereology & Leprology, 78(3), 279-289.
Kulkami, J. (2009). Textbook of Orthopaedics and Trauma. New York: Jaypee Brothers Publishers. Locking-Cusolito, H., Harwood, L., Wilson, B., Burgess, K., & al, e. (2005).
Prevalence of risk factors predisposing to foot problems in patients on hemodialysis. Nephrology Nursing Journal, 32(4), 373-84.
Milankov, M., Miljkovic, N., & Popovic, N. (2003). Concomitant plantar-+ tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations. Archives Of Orthopaedic And Trauma Surgery, 123(2-3), 95-97.
Meerabeau,L. (2011). Long Term Conditions: Nursing Care and Management. Boston: John Wiley & Sons.
The interviewee is a 21-year-old Hispanic female. She will be referred to as Maria. Maria had sought the help of a physician, as she had been having quite intense headaches for a while. The painkillers she had been taking had had only short-term effects. Maria drank mint tea to treat the headaches as well. She had some tests, completed some questionnaires, and answered the physicians questions. She was diagnosed with a migraine that was triggered by menstrual periods and stress.
The overall evaluation of that experience was negative. Maria noted that she accessed the services quite easily, but it was associated with a significant financial expenditure because she did not have the insurance at that moment. She felt the visit was necessary, as her family thought that the headaches could be symptoms of a more serious issue. Recently, one of her distant relatives had died of brain cancer. The interviewee claimed that she would think twice before paying another visit to this doctor, as it was too costly for her. She was specifically dissatisfied with the tests she had to take. Another most significant negative aspect was the communication with the physician.
She stressed that he had asked quite personal questions in a very improper way. Maria was dissatisfied with the way the physician interviewed her (his impersonal manner, different irrelevant questions). The interviewee emphasized that she was reluctant to answer many of the questions. She also mentioned her surprise and fear associated with the prescribed drugs. Maria wanted to hear about some more traditional ways to treat headaches. Maria would not describe the services she received as high-quality. She stated that her previous doctor was much better and more supportive and informative.
However, she did admit that the physician made the correct diagnosis and provided an effective treatment plan. She had fewer headaches within a very short period, and the pills helped to soothe the pain. However, Maria added that she had had to ask other professionals (and her family members) concerning ways to replace some pills, as she never trusted fully in pharmacological methods. Maria did not notice any bias, prejudice, or unfair treatment, but she stressed that the doctor was not very supportive and failed to become a person she could trust.
Analysis
The analysis of the patients account can help unveil potential areas for improvement within the US healthcare system. One of the major concerns associated with American health care is its affordability. People who do not have health insurance can hardly afford high-quality healthcare services, which makes them see a visit to a doctor as a last resort action. Clearly, this may have considerable adverse effects on their health, as well as public health, since people will address healthcare professionals only when costly treatment is needed and their health or even life is in danger (Griffin et al., 2016). Clearly, this is one of the areas where the system is failing to perform well.
The debate concerning the affordability of health care or even a shift to the public healthcare system is still ongoing in American society. The concept of interdependence may help make sense of this peculiarity of the American healthcare system. Historically, health care in the United States has been regarded as a service to be purchased by users. The interaction of diverse agents contributes to the maintenance of this approach. The physician who worked with Maria was one of those who accept the system as it is. He did not try to focus on the most relevant things while trying to avoid using less relevant procedures. He simply followed the standard procedure, which cannot be regarded as a patient-centered approach.
Another major concern is related to the area of doctor/patient communication. The physician failed to develop the appropriate communication patterns with the patient. First, the physician did not inform the patient about the importance of various tests, which made Maria think that many of them were a waste of her money. The patient stressed that she was not like her older relatives who distrust the healthcare system completely, but she still did not understand many things associated with her hospital experience. Juckett (2013) notes that proper communication (characterized by mutual respect and being informative) is the key to effective treatment of Latino patients.
It is necessary to note that the physician appears to be one of those who do not pay much attention to the cultural peculiarities of patients. According to adaptive systems theory, the systems are characterized by adaptability, as they can learn from their experiences and adapt to the changing environment. The modern US healthcare system is changing as it is transformed by different cultures and approaches existing in the world and in US society (Griffin et al., 2016). Healthcare professionals try to take into account the cultural peculiarities of their patients. Obviously, not all American healthcare practitioners have embraced this change.
The physician did not detect Marias emotional cues and did not take into account her values and beliefs. Blanch-Hartigan (2013) found that physicians inability to decode patients emotional cues led to the patients overall dissatisfaction with their experiences. As for the importance of values and beliefs, Latino patients tend to be quite religious, and all aspects of sexual life can be seen as too personal even for a conversation with a doctor (Juckett, 2013). Maria noted that she was not a teenager, but she found the physicians questions ( or mainly his tone ) concerning her sexual experience to be unacceptable. Notably, questions concerning menstruation and birth control drugs are common procedures, as these are some of the major triggers of migraines. Nonetheless, the physician had to explain the major triggers of migraine headaches and after that ask questions concerning this sphere of female life with the necessary degree of respect and modesty.
Finally, the treatment recommended was effective, but the physician failed to take into account the patients cultural peculiarities and needs. The medication prescribed was effective, but Latino patients tend to see traditional methods (for example, the use of herbs) as more desirable or even appropriate (Juckett, 2013). Maria was rather dissatisfied with the service and had to seek out other peoples advice. This practice can have quite negative long-term outcomes, as the patient will not trust the physician (as well as other healthcare professionals) and may seek assistance from others, including people who are unqualified. Self-organization has become a key solution to addressing similar situations.
Healthcare professionals ask their colleagues about the peculiarities of treating patients of different cultural backgrounds. Interprofessional teams are characterized by diversity in many respects (ethnicity, age, and so on). Healthcare professionals have self-organized to respond to emerging challenges. At present, interprofessional teams (including people of different backgrounds) have become a distinct system. However, it is clear that these systems do not operate properly in all clinical settings, and there are individuals who still tend to focus on practices used years ago. It is necessary to note that this analysis can help address the existing gaps in health care.
Insights for a Healthcare Manager
This interview provides valuable insights into the gaps associated with patient/client experience, some groups perspectives on the American healthcare system, and the implications for the healthcare manager. Healey and Marchese (2012) stress that healthcare managers have to use more flexible and creative methods to address emerging issues. The use of the concepts of adaptive systems theory can be one of these creative strategies. One of the major concepts of this theory to keep in mind is the non-linearity of systems. It is crucial to remember that even individuals can change large systems. Thus, the healthcare manager should believe that the efforts will lead to changes that are essential for the development of the US healthcare system.
The interview unveiled the lack of flexibility within the healthcare systemsome healthcare professionals continue to use standard procedures, despite the fact that some adjustments could be beneficial and could improve the patient/clients experience. It is noteworthy that all of the gaps revealed during the interview can and should be addressed. For instance, when it comes to the associated costs, the healthcare manager can improve the patient/clients experience. The healthcare manager should launch a series of discussions concerning the use of a more flexible approach to diagnosing and prescribing processes.
Standards are sometimes outdated and too rigid, so healthcare practitioners should be able to alter some procedures. In Marias case, it was possible to avoid some tests and prescribe fewer items. Clearly, this flexibility will require some changes in the healthcare facilitys norms and standards. These regulations will be needed to minimize medical errors, but they should provide more freedom for practitioners. It will also require quite extensive training and encouragement as many people try to follow standards to remain on the safe side. The healthcare manager can launch a reward system for employees who are ready to be more flexible.
Another significant gap is associated with healthcare professionals ability and willingness to take into account the patient/clients peculiarities to improve their experience. The healthcare manager should launch a series of training sessions concerning the cultural peculiarities of patients/clients and ways to address them. The training should be facilitated by the creation of a platform (it can be digital) where healthcare professionals share their experiences and concerns. The healthcare manager should also make sure that all practitioners use the skills and knowledge obtained. This can be implemented with the help of self-reports, performance reports, and patient/client questionnaires. Regular discussions should shed light on the numerous benefits of this approach for all stakeholders involved. For instance, it is important to stress that the number of ethnic minority patients is increasing, which makes it important to understand these populations better (Loder, Sheikh, & Loder, 2015). As a result of these efforts, all healthcare professionals of the facility can become informed, supportive, and sensitive to peoples diverse needs, values, and beliefs.
Finally, the healthcare manager will monitor the healthcare facilitys employees with a focus on such issues as the cultural and socioeconomic peculiarities of patients. Marias experience shows that there are many gaps even though the focus on the cultural diversity of patients has become a norm nationwide. It is clear that some practitioners are still reluctant to change, which negatively affects the provision of high-quality healthcare services, patient/client experience, and the overall development of the US healthcare system.
References
Blanch-Hartigan, D. (2013). Patient satisfaction with physician errors in detecting and identifying patient emotion cues. Patient Education and Counseling, 93(1), 56-62.
Griffin, P. M., Nembhard, H. B., DeFlitch, C. J., Bastian, N. D, Kang, H., & Munoz, D. A. (2016). Healthcare systems engineering. Hoboken, NJ: John Wiley & Sons.
Healey, B. J., & Marchese, M. C. (2012). Foundations of health care management: Principles and methods. Hoboken, NJ: John Wiley & Sons.
Juckett, G. (2013). Caring for Latino patients. American Family Physician, 87(1), 48-54.
Loder, S., Sheikh, H. U., & Loder, E. (2015). The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: Statistics from national survey studies. Headache: The Journal of Head and Face Pain, 55(2), 214-228.
Plantar fasciitis (PF) is defined as a painful heel with inflammation of the plantar fascia (Lemont, Ammirati & Usen, 2003). Bill has reported pain under the left heel. Bill is a 42-year-old with subcalcaneal pain which is a common orthopedic problem occurring in people between the age group of 30 to 70 years (Meyer et al., 2002). Diagnosis of PF can be reasonably made by Bills clinical assessment, history, and physical examination (Alvarez-Nemegyei & Canoso, 2006; McPoil et al., 2008). Patients of PF report severe pain especially during the first-morning activity involving walking usually after a period of inactivity (McPoil et al., 2008). PF patients experience morning pain along with inflammation and commonly present local calcaneal tenderness (Young et al., 2004). The pain usually reduces with activities such as walking or running but may tend to worsen towards the end of the day (Alvarez-Nemegyei & Canoso, 2006). Research indicates that patients generally report a recent change in the level of activity such as walking or running for increased distances or longer periods (McPoil et al., 2008).
Differential diagnosis of heel pain can be overwhelming in the absence of a systematic approach (Alvarez-Nemegyei & Canoso, 2006). The first point of interrogation is the actual place of pain which could be at the back or bottom of the heel or around the ankle (Alvarez-Nemegyei & Canoso, 2006). The next step is to consider any structural faults by examining motion and palpations. The final question should be aimed at finding any inflammatory and metabolic diseases in the patient (Alvarez-Nemegyei & Canoso, 2006). Some of the differential diagnoses which must be considered in patients with PF are calcaneal stress, bone bruise, fat pad atrophy, soft tissue primary or metastatic bone tumors, and severe disease (Alshami et al., 2008; Nuhmani, 2012). The differential diagnosis for Bill will include the following aspects.
Fat pad atrophy
Patients of PF having soft and thin heel pads could experience aggravated pain by wearing hard heeled shoes or walking on hard surfaces. Pain does not radiate and medial calcaneal tuberosity and PF are not tender (Alshami et al., 2008).
Tumors
PF pain has been uncommonly related to the presence of benign tumors in patients who occasionally complain of a local loss of sensation (Alshami et al., 2008).
Proximal nerve lesions
Proximal nerve disorders among patients of PF should be ruled out with neurological tests to confirm that the tibia nerve has not been compressed which could be a cause of pain being radiated to the heel (Alshami et al., 2008).
Biomechanical Assessment of PF
The diagnosis of PF is mostly clinically indicated by the pain location (Alvarez-Nemegyei & Canoso, 2006). An alternate diagnosis such as calcaneal stress fractures and soft tissue tumors may be ruled out with imaging studies such as ultrasound of the hind foot are preferred due to the low costs and high-resolution images (Alvarez-Nemegyei & Canoso, 2006).
Comprehension of the biomechanical factors affecting the development of tension in PF is crucial for enhanced management of the problem. A biomechanical assessment of Bill is necessary to rule out the prevalence of biomechanical risk factors such as pests planus, valgus heel alignment, and discrepancies in the length of the legs (Young et al., 2001). The biomechanical function of the plantar fascia is to provide support for the longitudinal arch of the foot and absorb any occurrence of shock during standing, sitting, or motion (Hunt et al., 2004). Since the plantar fascia is the primary means of stabilization for the arch of the foot, the anatomical position of the foot and the mechanical strength play a crucial role in the development of PF and pain associated with it (Nuhmani, 2012). Increased tension of the plantar fascia has been shown to deform it by 9% to 12% (Nuhmani, 2012). The plantar fascias breaking strength has been calculated approximately 1.7 to 3.4 times the body weight (Hunt et al., 2004). As such, it will be important to check whether Bills body weight is in excess and is a cause for PF. It has also been estimated that the tensile strength of the plantar fascia peaks at about 800N to 1000N during walking (Hunt et al., 2004). Bill needs to be investigated to confirm whether he engages in work or exercise which necessitates him to bear the strain of weight for long periods. Research indicates that pain in the heels can occur due to chronic damage of the tissues which have not completely been repaired (Hunt et al., 2004). The impact of cellular and tissue degenerations and loss of fiber has been noted to hurt PF with increased pain. Some patients with a long and chronic pain history of PF have shown evidence of inflammation of cells present within the involved tissues (Hunt et al., 2004). Bill needs to be assessed biomechanically to confirm the nature of his activities and whether these are responsible for PF and severe pain.
References
Alshami, A. M., Souvlis, T. & Coppieters, M. W. (2008). A review of plantar heel pain of neural origin: Differential diagnosis and management. Manual Therapy, 13, 103-111.
Alvarez-Nemegyei, J. & Canoso, J. J. (2006). Heel pain: diagnosis and treatment, step by step. Cleve Clin J Med, 73, 465-471.
Hunt, G., Sneed, T., Hamann, H. & Chisam, S. (2004). Biomechanical and histiological considerations for development of plantar fasciitis and evaluation of arch taping as a treatment option to control associated plantar heel pain: a single-subject design. The Foot, 14, 147153.
Lemont, H., Ammirati, K. & Usen, N. (2003). Plantar Fasciitis: A Degenerative Process (Fasciosis) Without Inflammation. J Am Podiatr Med Assoc, 93(3), 234-237.
Meyer, J., Kulig, K. & Landel, R. (2002). Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report. J Orthop Sports Phys Ther, 32(3), 114-124.
McPoil, T. G., Martin, R. L., Cornwall, M. W., Wukich, D. K., Irrgang, J. J. & Godges, J. J. (2008). Heel painplantar fasciitis: clinical practice guidelines linked to the International Classification of Function, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 38(4), 1-18.
Nuhmani, S. (2012). Plantar Fasciitis: A Review of Current Concepts. Indian Journal of Basic and Applied Medical Research, 5(2), 414-418.
Young, C., Rutherford, D. & Niedfeldt, M. (2001). Treatment of Plantar Fasciitis. American Family Physician, 63(3), 467-474.
I am writing on the topic of whitening strips and the pros and cons of their use in order to understand if their use is justified in any way or whether it should be terminated.
Main body
I want to write about whitening strips because a recent discussion of the subject matter has resulted in a range of controversies and a plaque of misinformation. While some sources claim that whitening strips are salvation for people, who have low pain thresholds or lack financial resources for carrying out the traditional whitening procedure, others state that whitening strips affect teeth negatively and may lead to their untimely decay. Therefore, the issue could use better insight.
The reason for me to be interested in locating the answer to the research question is rather basic; experiencing the necessity to take care of my looks in general and my teeth in particular, I am also very concerned about oral hygiene and the possible negative effects of the traditional whitening techniques. Seeing that whitening stripes are often viewed as a cheap and efficient alternative to an otherwise costly procedure, which is very painful at that, a range of people resort to using the specified tool as the key method for keeping their teeth white. The fact that whitening strips may harm teeth greatly, in its turn, is likely to reinvent many peoples concept of whitening strips. As a result, a range of people will be warned about the threat of their teeth deterioration and spared impressive costs. In case the opposite is proven, the rules for using whitening strips will be updated; moreover, awareness concerning the importance of using whitening strips may be created. In other words, the outcomes of the study are likely to benefit many people, which is the key reason for me to engage in this study.
When it comes to defining the people, who might have a stake in this research, every person, who cares about their oral hygiene and the aesthetics of their look, deserves to be mentioned. In other words, the patients of dentists can be viewed as the primary audience that the paper in question addresses. Apart from the target audience in question, the companies producing whitening strips need to be listed among the basic stakeholders. Finally, the students, who are interested in dentistry and are in search of trustworthy information on the subject matter, may also benefit from learning the outcomes of the study and identifying the choices that their future patients may benefit from.
In order to define the usefulness of whitening strips and state whether the specified tool can be considered a viable method for making the patients teeth look more aesthetic, one will have to answer several minor questions. Specifically, one will have to identify the benefits that the use of whitening strips entails. In addition, the negative outcomes of whitening strips use have to be identified. The results will be compared to the common myths about whitening strips. Moreover, a detailed comparison between the pros and cons of using whitening strips and the adoption of other approaches aimed at the same result will have to be conducted. Last, but definitely not least, one will have to locate the rates of whitening strips efficacy and identify them as either a useful tool in keeping ones teeth clean and white or the source of damage for ones teeth. Once the specified questions are answered properly, the key research question will be answered as well.
As has been stressed above, these are the common misconceptions about whitening strips that make the research very topical. Therefore, a range of traditional prejudices and myths about the use of whitening strips will be considered closely in the study. Particularly, the research will identify whether whitening strings can help whiten teeth despite the dental works that are attached to them, including caps, veneers, crowns, etc. Another dangerous myth, which is supposedly going to be proven wrong in the course of the research, the assumption that all teeth will acquire the same white color after the whitening procedure is over, will be busted. In addition, the dangerous myth about the expensive strategies for whitening being the most efficient one will also be explored; it is assumed that the quality of whitening does not necessarily have to correlate with the price quite on the contrary, in some cases, the two may be in an inverse proportion to each other. Speaking of which, the myth that not all people can afford whitening will also be analyzed thoroughly in the endeavor of proving it wrong. Moreover, studies show that a lot of people believe all whitening procedures to have the same effect on their teeth; the research in question, in its turn, will prove that the above-mentioned myth has nothing to do with reality.
To be honest, the idea of exploring the myths about whitening strips has gained a significant amount of importance for me as I started noticing the overhyped reactions about the use of the specified tool as the means of keeping teeth clean. Though the idea of incorporating the use of whitening strips into the overall array of methods for keeping ones teeth clean and healthy seems harmful enough, the backlash, which the approach in question has received recently from a range of people, was quite surprising, thus, making me investigate the problem of whitening strips usage. I must admit that I did not think much of using whitening strips as the key tool for maintaining the whiteness of ones teeth. In fact, it never occurred to me that there might be a problem.
After one of my family members stated, though, that they were going to use the specified approach as a less costly alternative to the traditional whitening procedure. At first, I was against the suggestion in question, as I assumed that whitening strips have a considerably less impressive effect on ones teeth. Moreover, I was under the delusion that whitening strips do not allow for adding the same whitish color to all teeth. Further research, however, has shown that the concern for the health of my family members, however, was partially groundless and that a range of myths concerning whitening strips have been successfully proved wrong. At present, I think that whitening strips work quite well as a tool for keeping teeth clean and neat, as well as adding the required tint of whiteness to them. Moreover, I am no longer delusional about the effects of a standard whitening procedure. Nevertheless, I am still quite suspicious about the subject matter and feel that the issue needs deeper research.
Conclusion
The preliminary research has shown that neither whitening strips, nor the standard medical procedures whiten all teeth equally. Moreover, it has been proven that some rather efficient whitening tools are rather cheap compared to the corresponding dental treatment. Finally, crowns and veneers, as well as any other kind of dental works, do not eliminate the possibility of whitening teeth, especially with the help of whitening strips.
Works Cited
Bruhn, Ann M., Michele L. Darby, Gayle B. McCombs and Carleen M. Lynch. Vital Tooth Whitening Effects On Oral HealthRelated Quality Of Life in Older Adults. The Journal of Dental Hygiene 86.3 (2012): 239246. Print.
Farrell, Stephen, Michael L. Barker, Daniel A. McMillan and Richard W. Gerlach. Placebo-controlled Trial Evaluating Safety with 12-Months Continuous Use of 6% Hydrogen Peroxide Whitening Strips. Journal of Dentistry 36.9 (2008): 726730. Print.
Gerlach, Robert. Professional Bleaching Using a Tin and Concentrated Peroxide Gel on Whitening Strips: An Integrated Clinical Study. Journal of Contemporary Dental Practice 5.1 (2004): 114. Print.
. Vital Bleaching with Whitening Strips: Summary of Critical Research on Effectiveness and Tolerability. The Journal of Contemporary Dental Practice 2.3 (2001): 115. Print.
Goldberg, Michel , Martin Grootveld and Edward Lynch. Undesirable and Adverse Effects of Tooth-Whitening Products: A Review. Clinical Oral Investigations 14.1 (2010), 110. Print.
Kim, Ji-Hyung, Yong-Keun Lee, Bum-Soon Lim, Sang-Hoon Rhee and Hyeong-Cheol Yang. Effect of Tooth-Whitening Strips and Films on Changes in Color and Surface Roughness of Resin Composites. Clinical Oral Investigations 8.3 (2004): 118 122. Print.
Oliveira, Gustavo M, Patricia A. Miguez, Greice B. Oliveira, Edward J. Swift and Svetlana Farrell. Safety and Efficacy of a High-Adhesion Whitening Strip under Extended Wear Regimen. Journal of Dentistry 41.3 (2013): 46 52.
Sulleman, Munther, Emma MacDonald and Jeremy S. Rees. The Effect of Hydrogen Peroxide Concentration on the Outcome of Tooth Whitening: an in Vitro Study. Journal of Dentistry 32.1 (2004): 295299. Print.
Sulleman, Munther, Emma MacDonald, Jeremy S. Rees, Robert G. Newcombe & Martin Addy. Tooth Bleaching by Different Concentrations of Carbamide Peroxide and Hydrogen Peroxide Whitening Strips: An In Vitro Study. Journal of Esthetic and Restorative Dentistry 18.2 (2006): 93100. Print.
Tredwin, Charles J., Simon Naik, Nicolas J. Lewis and Clair Scully. Hydrogen Peroxide Tooth-Whitening (Bleaching) Products: Review of Adverse Effects and Safety Issues. British Dental Journal 200, (2006): 371376. Print.
Traumatic spinal cord injury (TSCI) is associated with damage to the spinal bones. According to statistical data, every year, this type of injury accounts for 40-80 cases per million population (World Health Organization). The most common causes of TSCI include traffic accidents, falls from the height (including suicide attempts), degeneration due to disease, and so on (World Health Organization). Other common causes may also include medical errors committed during operations on the spine or traumas due to sharp turns of the head.
Types of TSCI
TSCIs are divided into two major groups: incomplete injury and complete injury ( Spinal Cord Injury ). The former refers to an injury that does not impair the functions of the spinal cord or causes only a partial functional impairment, while the latter implies the injury causing the complete rupture of the spinal cord. The incomplete injuries are most common. They comprise up to 60 percent of all TSCI cases ( Types of Spinal Cord Injuries ). The most common types of partial injury are anterior cord syndrome, central cord syndrome, and Brown-Sequard syndrome.
XII thoracic and V-VI cervical vertebrae are exposed to accident-associated TSCI most frequently and usually lead to fatal cases, while the lumbar the least (Zulkipli et al. 6). These findings support the assumption that the higher the injury occurs, the more severe the damage may be ( Spinal cord injuries par. 1). Even with minor spine injuries, the irreversible impairments of the spinal cord can be developed and, with more severe traumas, especially those associated with the narrowing of the spinal canal, the possibility for the severe brain damage increases (Hsiang 1). At the same time, damage to any section of the spinal cord may affect individuals sensory, motor, and reflex abilities.
The types of complete TSCI are tetraplegia, paraplegia, and triplegia ( Types Of Spinal Cord Injuries ). Immediately after the trauma, deep dynamic disturbances occur in the nerve cells and, due to this, their functioning becomes disrupted. In other words, the body becomes paralyzed starting from the location of the fracture and below. As a rule, the duration of a spinal shock depends on the severity of the injury. However, at the initial phase of all TSCIs, the picture of the spinal shock is identical, and it may largely complicate the diagnosis.
TSCI is associated with hematomyelia intramedullary hemorrhage, which can extend over several spinal cord segments (Rosman and Harini par. 6). This phenomenon is very destructive and most frequently occurs at the level of the cervical and lumbar thickenings. Its symptoms can manifest right after the injury and, as the bleeding increases, they can progress for several hours. One of the important symptoms of hematomyelia is the dissociated sensitivity disorder which implies the preservation of deep sensitivity and the loss of surface sensitivity. When the anterior ligaments of the spinal cord are affected, peripheral nerve paralysis can be observed (Rosman and Harini).
Rehabilitation
The success of intervention largely depends on such variables as the level of injury severity, types and degree of consequent impairments, the overall condition of the individuals health, and the availability of various sources of support (e.g., family) ( Spinal Cord Injury ). The therapy usually includes activities aimed at the development of mobility, socialization and communication skills, as well as physical care and psychological counseling. The ability to address both physiological and psycho-emotional needs of patients with TSCI may largely determine whether it is possible to assist him/her in returning functionality and independence.
Problems, Differential Diagnoses, and a Primary Diagnosis
Problems
The main concern of the 56-year-old patient is severe pain and inflammation in the knee. During the last three weeks, the pain was consistent. Physical examination shows swollen and erythematous with periarticular involvement. Regarding the laboratory results, several differentials and one primary diagnosis are defined.
Differential Diagnoses
Osteoarthritis of the knee, unspecified (ICD-10: M17.9) is one of the frequent forms of arthritis that bothers many people around the whole world and is characterized by severe joint pain (Silverwood et al., 2015). Among the main risk factors for the disease, the patient has several, including older age (56 years) and obesity (310 pounds). He has not addressed the doctors in the last 6-7 years. It is hard to research his history.
Hypertension (ICD-10: I10) is a common condition among older adults that lead to the development of numerous diseases and health problems such as infarction, strokes, and even death (James et al., 2014). Physical examination identifies BP 191/112. The results are higher than their normal values. Besides, the patient is at risk due to the presence of such factors as obesity (310 pounds) and age (above 45).
Obesity (ICD-10: E66) is defined as a disorder that is usually characterized by an extensive presence of fact in a body. The patients weight is 310 pounds, and his height is 58. BMI is 47.1. It is an evident sign of obesity. High cholesterol level (300 mg/dL is another sign.
Hypercholesteremia (ICD-10: E78.0) is a condition when the level of cholesterol is high than usual. The normal range should be from 100 to 130 mg/dL. The patients level of cholesterol is 300 mg/dL. Obesity is the main risk factor.
Primary Diagnosis
Pseudogout of the knee (ICD-10: M11.2) is also known as chondrocalcinosis and is characterized by severe pain in knee joints, inflammation processes, and changes in the laboratory tests. The patients complaint includes pain in the knee, and the examination proves inflammation. This disease is characterized by sudden pain and swelling. Besides, the high levels of cholesterol and Calcium should be taken into consideration because pseudogout results in joint inflammation caused by crystals of calcium pyrophosphate induction (Goroll & Mulley, 2014).
Pharmacological Plan for a Primary Diagnosis
The goal of the pharmacological plan is to remove or, at least, prevent the development and formation of new calcium pyrophosphate dehydrate crystals. No particular cure for this disease exists. Therefore, it is necessary to combine treatments and therapies. NSAIDs (nonsteroidal anti-inflammatory drugs) and colchicine should be offered to the patient at the first stage of the treatment (MacMullan & McCarthy, 2012).
A low dose of colchicine (0.5 mg) is suggested twice per day. These drugs should be taken orally. The number of times could be increased in case pain bothers a patient frequently.
Naproxen, as one of the possible NSAIDs, could be offered: 500 mg two types per day orally to relieve knee pain.
If the chosen drugs do not lead to the level of cholesterol is decreased, the use of such medications as Colestid or Lipitor two times per day should be prescribed.
Education for a Patient with Pseudogout
It is easy to cause a new cycle of an inflammation process in the knee. Therefore, the patient has to be properly educated about the main changes in the style of life and the risks of misunderstanding the main idea of treatment. The clarifications of appropriate diet should be given. The patient is obese, and much pressure on the knee is observed while walking. Diet and a healthy style of life are offered. Besides, the patient should make the joint rest for several days and use ice packs to reduce the inflammation process.
References
Goroll, A.H., & Mulley, A.G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,& Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520.
MacMullan, P., & McCarthy, G. (2012). Treatment and management of pseudogout: Insights for the clinician. Therapeutic Advances in Musculoskeletal Disease, 4(2), 121-131.
Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J. L., Protheroe, J., & Jordan, K. P. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthritis and Cartilage, 23(4), 507-515.
Nursing belongs to the most important professions of all the existing ones. Along with doctors, nurses take care of peoples health and welfare and make sure that each patient receives sufficient help, care, and education on a variety of issues. There are many trends in nursing that require additional research and financial support. I would like to lobby the legislators for funds to promote the global nurse workforce.
The Reason for Choosing the Issue
The rationale for choosing this trend to lobby is as follows. Global nursing is becoming more and more influential aspect of the world politics (Brokaw, 2016). Because nursing profession is one of the largest ones in the world, its representatives have a great potential to impact the global policy. However, there is are currently not enough opportunities for nurses in different countries to unite their efforts in the fight for better healthcare conditions all over the world. Therefore, I would like to ask the legislators to provide more funding to support the global nurse workforce.
When nurses unite their efforts, they will be able to arrange the improved quality of healthcare in a variety of spheres. The reason why nurses are the driving force of such a change is that they are the ones who spend the most time with patients during their stay at a hospital as well as after they are released from a healthcare institution. There are several barriers in the development and promotion of global nursing that are provoked by the insufficient funding.
The major problem is that nurses have a rather limited access to policy-making opportunities at the moment. Meanwhile, being the largest medical profession throughout the world, nurses are the ones who should be able to redesign the system of providing healthcare (Brokaw, 2016). In order to reach such an opportunity, nurses need to unite their efforts and exchange their experience. Therefore, they should be able to communicate and share their knowledge and discuss a variety of practical issues at meetings and conferences. Even virtual conferences require much financial preparation since it is not possible to arrange such a communication without high-quality equipment.
The next weakness of the current situation is that nurses frequently experience burnout that leads to dissatisfaction with the job and disappointment in ones career choice. Under such circumstances, there is no possibility for nurses to discuss global issues in healthcare since they are preoccupied with their everyday chores due to understaffing of hospitals. Thus, the second reason why I am lobbying for global nurse workforce is that giving nurses from different parts of the world an opportunity to exchange their methods of coping with complicated situations will enable them to develop more productive ways of managing burnout. As a result, the turnout among nursing professionals will become lower, and nurses job satisfaction will be higher.
It is vital to support the global nurse workforce since life and health of millions of people depend on nursing professionals on a daily basis. By giving these professionals an opportunity to unite their strengths, the legislators will promote the elimination of weaknesses in this sphere. Therefore, the most beneficial outcomes both for professionals and customers will be achieved.
The Current Relevance of Material
Many of recent research studies and review articles are dedicated to the issue of global nursing. Auerbach, Staiger, Muench, and Buerhaus (2013) emphasize the need for innovative approaches to the nursing workforce in the healthcare reform era. In their study, the authors note that the role of nurses is expected to become even more significant in the nearest decades. Auerbach et al. (2013) remark that the global nurse workforce has a potential to increase the quality of care and implement innovative prevention methods. The authors point out that changes in healthcare system will require a much better coordination among healthcare specialists, which explains the necessity of global connections between the professionals. Auerbach et al. (2013) also mention that educational programs for nurses are vital since they enable specialists to arrange a continuous development and allow them to stay aware of the most recent trends in the sphere.
Premji and Hatfield (2016) also discuss the significance of global nursing. The scholars note that the global healthcare workforce is mostly comprised of nurses, and their cooperation can lead to the better health outcomes. The authors emphasize the importance of a new vision that incorporates collaboration and enthusiastic participation in international policy-making and practical dimensions. Premji and Hatfield (2016) remark that expansion of nursing engagement in global health may become possible due to the adoption of a new approach One World, One Health (p. 1). Thus, scholars mention that in order to reach the best healthcare outcomes, nurses need to engage in international practices and exchange their experience. By doing so, specialists will become able to fill in the gaps in their local approaches and adopt unified techniques that will combine the best practices. Premji and Hatfield (2016) suggest two concepts of guiding the global connections in the sphere of nursing: two-way learning and reverse innovation. With the help of these approaches, nurses are expected to reach the best results of their global partnership.
Another recent study focused on the global nursing workforce was performed by Jones and Sherwood (2014). In their article, authors promote the need for globalization of health care as the most advantageous way of enhancing peoples health. Jones and Sherwood (2014) remark that global nursing makes it possible to traverse the boundaries existing in healthcare system and, as a result, leads to significant improvements. In order to meet the global needs, nurses need to travel within and among the countries, which allows arranging new opportunities for their profession (Jones & Sherwood, 2014). Therefore, there are many materials proving that the trend is relevant and has earned much attention from the specialists in various spheres who consider the globalization of nursing a beneficial option for everyone.
The Integration of the Issue into Clinical Practice
The concept of global nurse workforce is closely related to clinical practice since nurses work is inseparable from healthcare facilities. The integration of global nursing into clinical practice is noted by specialists and researchers (Van den Heede & Aiken, 2013). The outcomes of such an assimilation are rather beneficial since the more aware nurses are about new methods and technologies, the sooner they will be able to implement them in practice. The ultimate aim of global nursing is making clinical practice more efficient and productive both for the patients and nurses. With the help of new knowledge and shared experience, nurses all around the world will be able to provide their customers with high-quality care and arrange the best working conditions. The knowledge gained through the innovative experience and practice can be employed in clinical practice with further analysis of the achievements.
The Use of Information in Clinical Settings
The information obtained through global nurse workforce may be used in clinical settings to reach the most advantageous results for the patients of healthcare institutions. Also, with the help of such data, nurses will become able to eliminate the negative issues of their profession such as burnout and high turnover. Managers in clinics will be able to outline the most productive strategies and further employ them in practice. Nardi and Gyurko (2013) remark that there are currently many problems in clinical settings due to the insufficient development of global nurse workforce. It is necessary to arrange the centralized recording of data so as to simplify understanding of medical recordings by specialists throughout the world (Nardi & Gyurko, 2013). Also, there is an acute need for altering the educational paradigm of nursing professionals. Scholars emphasize the necessity of arranging international cooperative programs and policies (Nardi & Gyurko, 2013). Furthermore, it is important to remove restrictions in advanced practice. These and other issues benefit from the use of the information on global nursing in clinical settings
Conclusion
Global nurse workforce has developed into a significant trend in the modern healthcare system. Therefore, it is necessary to pay much attention to the progress of this issue since it is aimed at the improvement of healthcare services as well as making the working conditions of nurses more favorable. I would like to lobby legislators for funds to support global nursing because I find it the most beneficial trend in modern medicine.
References
Auerbach, D. I., Staiger, D. O., Muench, U., & Buerhaus, P. I. (2013). The nursing workforce in an era of health care reform. The New England Journal of Medicine, 368(16), 1470-1472.
Jones, C. B., & Sherwood, G. D. (2014). The globalization of the nursing workforce: Pulling the pieces together. Nursing Outlook, 62(1), 59-63.
Nardi, D. A., & Gyurko, C. C. (2013). The global nursing faculty shortage: Status and solutions for change. Journal of Nursing Scholarship, 45(3), 317-326.
Premji, S. S., & Hatfield, J. (2016). Call to action for nurses/nursing. BioMed Research International, 2016, 1-5.
Van den Heede, K., & Aiken, L. H. (2013). Nursing workforce a global priority area for health policy and health services research: A special issue. International Journal of Nursing Studies, 50(2), 141-142.
The mental status exam (MSE) is a process that delivers information about the patients current mental state. The examination is conducted primarily through observations and interviewing that is used to verify the available historical data. Thus, it serves as a validation technique. It is important to understand that the results of an MSE can, and often do, contradict the findings of a biopsychosocial assessment that is usually based on historical data and may not represent the latest changes in the clients mental state.
The goal of an MSE is the review of psychiatric functions and is usually conducted informally despite the existence of a number of standardized formats (Wiger, 2012). The information is gathered throughout the session and targets specific components such as language, appearance, the level of activity, cognition, mood, and judgment. The physical appearance in combination with respective historical information could indicate or confirm an existence of a disorder or point to the important area of inquiry. However, it is important to remember that such data alone is insufficient for making a definitive conclusion and requires careful verification.
The abnormal activity level is usually indicative of the existence of psychological concerns and should be reported whereas the absence of deviations can be omitted from the report. The clarity of speech can be used as a criterion for determining the mental status, where the disrupted sentence structure and improper grammar usage point to the possibility of cognitive, neurological, or psychotic dysfunction. The lack of congruence between affect and mood reflects the inconsistencies in the clients emotional state and suggests the existence of a psychopathology (Wiger, 2012). Finally, cognition is a combination of factors such as attention span, orientation, memory, and concentration which collectively determine the mental state of the client.
Reference
Wiger, D. E. (2012). The mental status exam. In D. E. Wiger, The psychotherapy documentation primer (3rd. ed.) (pp. 81-94). Hoboken, NJ: John Wiley & Sons.
WILLINGTON (28 JULY) A traffic incident on the South Market Street has led to the overturning of two vehicles. Four of the passengers were children and all received injuries of different severity.
The incident was reported at 1:30 p.m. on Thursday, July 27 and involved four separate vehicles. One of the vehicles, a 2013 GMC Yukon, contained four children aged between 9 and 12. The vehicle flipped upon impact, causing injuries of various severity in all of the four children. The children were admitted into the (Hospital Name) at 1:55 p.m. on July, 27th. One of the children remains in critical condition and unconscious. Another childs condition is serious, and the remaining two are in fair condition.
All children were rushed to the hospital by the EMS shortly after the incident, which helped to preserve vital functions until arrival to the hospital. Physicians and nurses have been attending to the patients ever since. One of the patients required surgery, whereas three of the children acquired fractures and other tissue injuries as a result of the incident. The hospital team is working hard to ensure that all patients recover from the incident and are allowed to go back home as soon as possible. Two of the children are in fair condition, meaning that they will most likely be released from the hospital by the end of the week.
Currently, our best efforts are aimed at:
returning all children to good condition and facilitating recovery by administering required medication and treatment;
providing advice and counseling to parents to equip them with skills and knowledge necessary to ensure smooth recovery;
assisting the local law enforcement in the investigation and relief efforts by providing information on the condition of patients and their progress to recovery.
We hope that all the patients will benefit from our efforts and will be released from the hospital as soon as possible. Further updates on the patients condition and progress will be provided once more information is available. In the meanwhile, you can help these and other patients to recover faster by donating to our hospital.
How You Can Help
(Hospital Name) is a non-profit facility that relies on donations from individuals and organizations. Whether you are a local resident or live in other areas of the United States, you can help us care for the victims of the traffic incident, as well as for many other children who are currently being treated in the facility. We accept monetary donations of all sizes and use the funds to diagnose and treat patients, as well as to promote research and education in our facility. You can find more information on donating on our website.
Children in intensive therapy, as well as those suffering from many serious conditions, also require blood transfusions on a regular basis. To help us care for these patients, you can become a blood donor. Whether you want to become a regular or a one-time donor, you can assist us in saving a childs life. To find out more about becoming a blood donor, contact reception by phone or e-mail.
We also accept other donations, including toys, clothes, and other items that are essential to providing our patients with the best care possible. We are always looking for volunteers to assist with our events and fundraisers. To find out more about ways in which you can help children, please visit the Ways to Help section on our website.
My opportunity to serve mankind came in the most unexpected of ways, but fulfilled a desire that had become part of my conscience for many years. A friend called me after I finished my undergraduate studies to inform me of his desire to visit Africa for a short holiday. This particular friend requested my assistance in helping her to find all the best tourist sites she could visit in Africa, especially in Kenya, Egypt, and South Africa. While I was searching for the sites, I bumped into a website with pictures of children suffering from cleft palates, with a caption indicating that all they needed was $40 for surgery to be performed on them, but couldnt raise the money due to their poor backgrounds. Some help-line numbers had been scripted below the caption. My raw desire to be of service to mankind triggered me into calling the numbers given to pledge my financial support for the children. This is how I came to know about AMREF USA.
AMREF is the largest indigenous Health organization in Africa, operating in ten countries in Sub-Saharan Africa, and has over 15 offices worldwide. Its office in the US is based in New York City, and this is where I offered my voluntary services. The main functions of the US office is to arrange for fundraising activities as well as coordinate logistics for US program officers running healthcare programs in a number of African countries under the auspices of AMREF.
After a brief stint as a volunteer liaison officer for fundraising, I was requested to coordinate logistics and funding for a new healthcare program targeting people living with HIV in Kenya. I was to liaise with US volunteer personnel on the ground to make sure that everything was progressing as planned. My tasks, however, revolved around the New York City office, and did not in any way entail travelling to the field. I was also tasked with the duty of soliciting for cheaper antiretroviral drugs from drug manufacturing companies in the hope of saving thousands of people who were dying from the scourge within the program area. I knew it was a tall order for me, but one which I was ready to surmount.
Having laid down a firm strategy for the HIV program, I engaged a group of five other volunteers in a spirited attempt to seek for willing donors for the project. After several initial disappointments, I managed to get two multinational companies to voluntarily fund the HIV program to a tune of $50, 000 per year. 90% of these funds went directly into purchasing antiretroviral drugs for pregnant mothers and children, while the remaining 10% catered for other office logistics. I was also able to convince a drug-manufacturing company with offices in New York City to start producing generic anti-retroviral drugs, which are cheaper in the market compared to original regimens. We used the funds availed by our donors to buy the generic drugs and ship them to the program area in Africa. As a result of this effort, many people have access to antiretroviral drugs and the death rates caused by the virus went down by over 70%.
I gained a lot of knowledge from my volunteer work, especially in areas of financial management and allocation, negotiation skills, and leadership. I also learnt some basic office management practices, including work scheduling, time management, and logistics management. My contact with people from different social and cultural backgrounds as I solicited for funds in the US was an eye opener as it enabled me to realize that there is a lot of potential in diversity.