Category: Health & Medicine

Psychiatric medications are a part and parcel of a treatment program aimed at addressing a problem in the mental health domain in children. However, the identified medicine must be prescribed by the therapist with a license and administered in an appropriate fashion. Unfortunately, studies show that a range of healthcare system members abuse their power by addressing the issues that they do not have legal permission to and, therefore, prescribing psychotropic medications without due qualifications for doing so. As a result, children with mental issues suffer from side effects caused by the medications, developing other disorders. Therefore, the paper will aim at designing the strategy that will help eliminate the phenomenon in question.

Significance

Seeing that the paper will help prevent the negative outcomes of wrongly prescribed medications, its significance can be deemed as very high.

Scope

Organizational Leadership and Management Strategies: Promoting Quality and Sustainability

A closer look at the subject matter will show that the problem under analysis is related to the organizational and managerial issues rather than the ones regarding healthcare. First and most obvious, the enhancement of the quality standards can be carried out by the manager so that the prescription of psychotropic medication should be provided in the cases that actually need the application thereof.

For these purposes, the concept of sustainability will have to be incorporated into the existing framework. Because of the necessity ti provided therapists with financial incentives that will enhance the development of proper ethical standards and the concept of Corporate Social Responsibility (CSR), there is a strong need to change the existing organizational leadership strategy. Particularly, it is strongly suggested that the principles of the transformative leadership style should be adopted in the designated are. Seeing that the identified approach allows for a successful promotion of a particular organizational behavior model, it can be deemed as fairly efficient in encouraging the staff members to make the right choices in case of ethical dilemmas.

As far as the management strategies are concerned, the policy of strategy choices can be advised as the primary tool for dealing with the current inconsistencies in administering psychotropic medicine to children and adolescents. Allowing to get the priorities straight, the identified approach serve as the tool for improving the quality of the services provision significantly (Sharma et al., 2016).

Human Resource Management and Financial Acumen as the Pathway to Promoting Sustainability and Improving Healthcare Quality

Choosing the HRM approach, one should give credit to the Corporate Social Responsibility (CSR) framework as the most efficient one. It will help encourage the employees to accept the new standards and strive for a steep professional progress.

However, the changes listed above will demand that an entirely new financial policy should be implemented in the organization. Specifically, the emphasis on the sustainable use of the existing resources should be put. Thus, the finances can be allocated in the most reasonable manner possible. The departments that need funding badly, e.g., the R&D and the logistics-related ones, will receive the amount of money necessary to launch new projects.

In addition, a new financial system will have to incorporate an elaborate system of audits. Thus, the threat of financial fraud can be avoided.

Defining the Organizational Design, Governance, and Public Policy Strategies: Managing the Problem

Seeing that the promotion of change in the organization will be carried out by reconsidering the existing OB framework and the leadership approach, therefore, implying a change in the corporate ethics, McKinseys 7S Model can be viewed as a possible tool for creating a new organizational design. As the chart below shows, corporate values are at the top of the priorities list, therefore, serving as a foil for the further improvement in service quality.

The introduction of governance can be viewed as a rather risky step as it will mean that the internal processes will be controlled by the people who have a very basic understanding of the specifics of a certain affiliate of the organization (Alavi & Calleja, 2012). Therefore, the governance process should be rather loose, avoiding to dictate a rigid set of actions yet supervising the essential process closely.

Ethical Leadership Skills and Dispositional Attitudes to Stop the Abuse of Psychotropic Medications

Apart from adopting the transformative leadership approach, one should also consider the trait leadership framework (Fontanella et al.,2014). Since the strategy above allows for making the staff members enthusiastic about the adoption of the new behavioral patterns, it will convince them to base their choices on the healthcare ethics. In other words, the employees will be encouraged to focus on the needs of the patient as their priority. Apart from serving as the means of avoiding possible negative outcomes caused by the prescribed psychotropic medicine, it will also help apply a patient-centered approach, therefore, improving the healthcare services significantly.

A Plan, a Partnership, and a Policy to Consider: Choosing the Appropriate Set of Tools

Plan

1. Introducing the transformative leadership strategy into the target environment
2. Creating a range of incentives for the healthcare service members;
3. Developing the program enhancing the staffs knowledge and competencies as far as the provision of psychotropic medicine to children is concerned;
4. Introducing the staff members to a new set of ethical principles with a strong emphasis on the importance of customer satisfaction and the need to strive from the patients wellbeing;
5. Evaluating the progress and setting goals for the further development of the healthcare services and its member.

The concept of partnership can be introduced into the organization by making a connection with another healthcare institution. Thus, the process of sharing experience and knowledge can be launched, therefore, serving as the prerequisite to the staffs further progress, including both personal and professional development (Memari et al., 2012).

Finally, regarding the policy, one should view the concepts of a Just-in-Time (JIT) approach and the framework of Total Quality Management (TQM) as the tools that can possibly improve the current situation. The TQM strategy will serve as the means of enhancing the acquisition of the necessary skills, whereas the JIT approach will create premises for conducting the innovation within the shortest amount of time possible.

Conclusion: Implications of the Strategies to Be Used and The Course for the further Development

Since a range of therapists abuse their power by prescribing psychotropic medicine to children without the right to do so, thus, endangering the patients, a radical change in the context of the current healthcare organizational environment must be made. Making changes in the healthcare setting design is a challenging yet necessary step; particularly, a redesign of the leadership strategy and the subsequent change in values need to be carried out. By applying a different leadership model and enhancing the significance of healthcare ethics, leaders will be able to stop the current power abuse issue and create a safer environment for young patients.

Terms

A psychotropic medication is the medicine that affects ones cognitive processes and emotional perceptions (Memari et al., 2012).

Off-label prescriptions are the prescriptions that have not been approved by the FDA (Sharma et al., 2016).

Reference List

Alavi, Z., & Calleja, N. G. (2012). Understanding the use of psychotropic medications in the child welfare system: Causes, consequences, and proposed solutions. Child Welfare, 91(2), 77-94.

Fontanella, C., Hiance, D., Phillips, G., Bridge, J., & Campo, J. (2014). Trends in psychotropic medication use for medicaid-enrolled preschool children. Journal of Child & Family Studies, 23(4), 617-631. Web.

Memari, A. H., Ziaee, V., Beygi, S., Moshayedi, P., & Mirfazeli, F. S. (2012). Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: Perspective from a developing country. Research in Developmental Disabilities, 33(2), 563-569. Web.

Sharma, A. N., Arango, C., Coghill, D., Gringras, P., Nutt, D. J., && Hollis, C. (2016). BAP position statement: Off-label prescribing of psychotropic medication to children and adolescents. Journal of Psychopharmacology, 30(5), 416-421. Web.

Introduction

It is worth noting that the articular and muscular systems are the two most important parts of the human body due to the fact that they perform the functions of the musculoskeletal system. This system provides the volume of motion of the skeleton relative to the fulcrum. The purpose of this paper is to review this system and describe its peculiarities.

Articular System

Joints are discontinuous, hollow, and mobile links between bones. Each joint in the human body has basic elements such as articular surfaces, an articular cavity, and so on. In addition, there is also an auxiliary apparatus. In particular, the articular ligaments, discs, meniscus, and synovial membranes are parts of this system (Schuenke, Schulte, & Schumacher, 2015). Joints are quite strong. In their strength, the tension of the ligaments of the joint, muscle traction, pressure, capillary tension between the articular surfaces is important. Due to these aspects, the joints are strong and allow the person to move around in space.

The joint fluid is particularly important in this system since it reduces the friction between surfaces during motion. A similar function is also performed by smooth cartilage covering the joint surfaces (Rizzo, 2010). In general, the main function of all joints in the human body is their participation in the movement. In this connection, they act as dampers since they quench movement inertia and help to stop instantly in the process of moving.

Muscular System

In the human organism, there are almost 600 individual skeletal muscles. The comparison of a number of muscles of the limbs made it possible to reveal a mosaic pattern in the distribution of fibers (Schuenke et al., 2015). It is important that some muscles have an internal arrangement; other tissues are attached to bones, skin, and other muscles in order to provide certain movements. Muscles can move arbitrarily and involuntarily depending on the type of tissue (Swisher, Patton, & Thibodeau, 2014). In general, three categories can be identified in this system, which is cardiac, visceral, and skeletal muscle tissue. Any of these types of tissue consists of water, inorganic substances (such as mineral salts), and organic substances (this includes myoblasts that form muscle cells).

The majority of the muscles are attached to bones through the strong fibrous connective tissue (tendons) (Rizzo, 2010). However, muscles can be both fixed and movable. There are two types of muscle movement such as concentric and eccentric contraction (Swisher et al., 2014). The first type is a shortening of the muscle, while the second is its elongation. In general, the muscular system has three functions including movement, holding the body, and producing heat. However, overall, all muscle groups ensure the correct location of the body, which contributes to the overall health of a person.

Conclusion

Thus, it can be concluded that these two systems perform the musculoskeletal function. The muscles and joints serve as the power unit. The skeletal muscles furnish any movement of the body related to walking, nutrition, and labor processes; therefore, their healthy functioning is the key to the well-being of a person. Almost every movement is a complex activity involving the work of many muscles and joints. The magnitude of an effort and strict sequence of actions is controlled by the central nervous system. Due to the impulses from the nervous system, the muscles of the person are in constant tonus and, together with the work of joints, they provide a stable position of the body.

References

Rizzo, D. C. (2010). Fundamentals of anatomy and physiology (3rd ed.). Boston, MA: Cengage.

Schuenke, M., Schulte, E., & Schumacher, U. (2015). Fundamentals of anatomy and physiology (4th ed.). Boston, MA: Cengage.

Swisher, L., Patton, K., & Thibodeau, G. (2014). Study guide for anatomy & physiology (9th ed.). Elsevier.

Identify an analysis model that best fits your group project identified

The analysis model that best fits the implementation of the clinical information system (CIS) in five hospitals accounts for the facts that are important to the project. In addition, the analysis model acts as a foundation that will be useful to the design of the system. One analysis model that can be applied to CIS implementation is data collection. Data collection involves collecting data that is pertinent to the project, refining it to suit the needs of the project, and creating a workflow document (Johnson & FitzHenry, 2006). The data-collection analysis model also takes into account some of the basic assumptions that apply to CIS implementation, all the important tasks that apply to the project, and a record of all the other simple tasks that apply to the process.

There are several diagrams that can be used in the data-collection model of analysis. These diagrams can be used to capture the contents of flow sheets, procedure manuals, questionnaires, observations, and interviews. An activity diagram can be used to sequence the activities that the CIS project is seeking to harmonize. Consequently, the activity diagram can be used to outline the activities that transpire during patients clinical visits. The activity diagram also identifies the sequence of activities in relation to patients, pharmacists, and other physicians.

Mock Draft-Sample Activity Diagram.

You have been assigned as a team member for a clinic scheduling system that will be used throughout the outpatient clinics. The project leader is asking for team input into how to approach the fact-finding. Discuss how you would approach the fact-finding. Design a sample tool that could be used for fact-finding during the analysis phase.

The fact-finding mission for a clinic scheduling system begins the process of determining its importance to the clinical setting. It is also important to determine the variables that apply to clinic scheduling including arrival and service time variability, patient and provider preferences, the available information technology, and the experience levels of the staff (Gupta & Denton, 2008, p. 802). The actual fact-finding mission starts with the identification of a team leader, who is responsible for coming up with a team that carries out the project.

In a fact-finding mission, it is important to outline the groups priorities throughout the duration of the project. Setting up priorities helps in determining which tasks should be expedited. In the fact-finding process, some tasks have to be performed while others can be substituted. For instance, the major priority when identifying a clinic scheduling system is determining the features that have to be included in the chosen scheme.

Furthermore, fact-finding has to account for the needs that have to be satisfied with a scheduling system. The trigger for this fact-finding mission is the need to streamline activities in various outpatient clinics. Consequently, fact-finding has to address this trigger consistently throughout the process of searching for solutions. In the course of looking for solutions, it is important to utilize case studies especially the ones that pass standard scientific thresholds. Case studies are used to determine preconditions, post-conditions, and exceptions that apply to clinic scheduling systems.

Sample Tool

A good tool for fact-finding during the analysis phase should address three important questions that touch on expected accomplishments, positive changes, and change-identification. A sample tool that can be used in the fact-finding phase is the Triple Action Approach (TAA). TAA seeks to master the data manipulation process by stressing the need to define, measure, and analyze data. These three processes are key to successful fact-finding.

References

Gupta, D., & Denton, B. (2008). Appointment scheduling in health care: Challenges and opportunities. IIE transactions, 40(9), 800-819.

Johnson, K. B., & FitzHenry, F. (2006). Case Report. Journal of the American Medical Informatics Association, 13(4), 391-395.

Background

Characteristic Symptoms

As a mental disorder, aphasia has characteristic symptoms that impair language and speech proficiency among individuals. The characteristic symptoms of aphasia are evident as they affect the four aspects of communication, namely, verbal expression, auditory comprehension, functional communication, and reading and writing competence (Chapey, 2008). In the aspect of verbal expression, individuals with aphasia have difficulties in expressing some words in an appropriate manner.

For example, aphasic individuals tend to substitute words with other related words, switch sounds by reading words in reverse, and create their words and phrases (Chapey, 2008). Aphasic individuals also have difficulties in forming sentences and communicating verbally in a sensible way for they use a string of words that do not make sense (Wilson, 1999). In the aspect of auditory comprehension, aphasic individuals have difficulties in comprehending verbal language, figurative speech, and jokes. Consequently, aphasic individuals have limited functional communication because they cannot use words appropriately and comprehend what other say (Ogden, 2005).

Fundamentally, aphasic individuals cannot communicate in a normal way because they have comprehension and verbal difficulties. Wilson (1999) asserts that aphasic individuals do experience challenges in reading and writing for they cannot understand concepts, words, and ideas. Moreover, aphasic individuals cannot read and write for they cannot interpret words and sentences and present them in a logical manner.

Neuropathology Associated with the Syndrome

Aphasia is a mental disorder that affects language and speech functions of the brain. Neuropathology shows that aphasia emanates from the damage of the parts in the left hemisphere of the brain such as Brocas area, Wernickes area, and posterior language area (Jordan & Kaiser, 2013). The main cause of aphasia is a stroke while brain injury, neurological disorders, and tumor are minor causes because they damage the brain and impair its functions (Jordan & Kaiser, 2013).

The cause and the site of the brain affected determine the severity of the aphasia. Stroke causes aphasia by damaging Broca and Wernickes areas of the brain and impairing speech production and comprehension respectively (Jordan & Kaiser, 2013). Ischemic stroke, which is a form of stroke that occurs due to the blood clot in the brain, is the common cause of aphasia. The blockage of the blood vessels that supply blood to the brain, particularly the left hemisphere, results in the death of brain tissue (Macdonald, 2011).

The form of stroke called hemorrhagic stroke also causes Brocas aphasia, global aphasia, and Wernickes aphasia when the blood vessels burst in the left hemisphere of the brain and causes internal bleeding, which affects tissue and functioning of the brain. Moreover, mechanical injury of the brain or neurological disorders, which damage Brocas area and Wernickes area, causes aphasia (Plowman, Hentz, & Ellis, 2011). In essence, any damage to the left hemisphere results in aphasia among individuals.

Diagnostic Procedures

Halstead screening test comprehensively diagnoses the characteristic symptoms of aphasia. Specifically, Halstead screening test assesses aphasic individuals regarding the extent of fluency, repetition, and comprehension (Salter, Jutai, Foley, Hellings, & Teasell, 2006). Aphasic individuals exhibiting non-fluent characteristics with poor repetition and poor comprehension have global aphasia while those with poor repetition and good comprehension have Brocas aphasia (Salter et al., 2006).

Moreover, aphasic individuals having non-fluent characteristics with good repetition and poor comprehension have mixed transcortical aphasia whereas those with good repetition and good comprehension have transcortical aphasia. In contrast, aphasic individuals having fluent characteristics with poor repetition and poor comprehension have Wernickes aphasia whereas those with poor repetition and good comprehension have conduction aphasia (Salter et al., 2006).

Furthermore, aphasic individuals having fluent characteristics with good repetition and poor comprehension have transcortical sensory aphasia while those with good repetition and good comprehension have anomic aphasia. Hence, assessment of individuals using Halstead screening test provides a robust diagnosis of aphasia.

Treatment Programs

Since aphasia has numerous causes, it has different treatment programs, which are effective in the treatment and management of the condition. Multimodal treatment programs such as vision action therapy (VAT), promoting aphasics communicative effectiveness (PACE), and oral reading for language in aphasia (ORLA) are applicable in the management of the condition and improvement of speech and language proficiency (Wallace, Purdy, & Skidmore, 2014). VAT is treatment program used in the treatment of patients with global aphasia because it improves the ability to communicate using gestures (Purdy & Van Dyke, 2011).

PACE is a treatment program that improves speech, comprehension, and functional communication among aphasic patients (Wallace, Purdy, & Skidmore, 2014). ORLA is a treatment program that boosts visual, auditory, and writing capacity of aphasic patients. According to Purdy and Van Dyke (2011) assert that the multimodal communication programs are effective in the treatment and management of aphasia for they collectively enhance various brain functions. Hence, PACE, VAT, and ORLA are some of the multimodal programs that are applicable in the treatment of aphasic patients.

Case Study

Patient History/Background

Martin is a 24-year old aphasic patient who has been battling with aphasia for five years. Since childhood, Martin has been healthy for he has no medical history of major or chronic diseases. However, Martin started experiencing headaches and dizziness, which eventually led to the aphasic symptoms. As Martin was an active and social person, his friends realized that he was no longer active and social as usual, and his and lecturers reported that they observed problems in his writings.

Martin started aphasic symptoms for he lost the ability to communicate fluently in both speech and writing. The aphasic symptoms prompted him to seek medical attention from the same hospital. The clinical assessment using Halstead screening test revealed that Martin has a problem in his Brocas area part of the brain because he presented aphasic symptoms. Therapist put him on multimodal programs, namely, VAT, PACE, and ORLA for a duration of six months. Currently, Martin is improving well for he is responding well to the treatment programs and continuing with his studies.

Incident that Gave Rise to Aphasia

The incident that gave rise to aphasia is the head injury that Martin sustained while playing football with his friends in the field. When he was 20 years old, Martin sustained the head injury, which caused internal bleeding on the left hemisphere of his head and subsequently caused aphasia. While playing, Martin collided with his friend in a football match they were playing and sustained minor head injuries, which were visible on the surface of the head.

Although his colleagues took him to the hospital, the doctor confirmed that it was a minor injury through a computerized tomography (CT) scan and dressed the visible wound on his head. Although Martin appeared healed during the first three months for the doctor dressed the wound on the head, the internal injury remained unhealed. With time, the internal bleeding caused a blood clot and interfered with the functioning of the brain. Analysis of other possible causes of aphasia showed that the head injury was the only plausible cause because Martin has not suffered a stroke, infection, or cancer. The brain scan confirmed that Martin had a blood clot in the region of the head where he sustained injury.

Presenting Symptoms

The symptoms that Martin presented are headache and dizziness. These symptoms indicated that the problem that Martin was suffering from was in the head for he experienced an unusual headache and dizziness following the injury. Moreover, given that friends noted that Martin was unable to communicate fluently as he used to be, they realized that his mental state was not in good condition. A notable symptom that his colleagues realized is that Martin spoke with lisp, which was quite usually.

Additionally, Martin started communicating in an incoherent manner for he lost fluency gradually and eventually revealed that he had a mental condition, which progressively affected his ability to communicate effectively with people.

As Martin was unable to socialize and communicate effectively, he appeared withdrawn and depressed. Chapey (2008) explains that aphasic individuals grapple with stress and depression because they realize their inability to communicate effectively and socialize with people. Furthermore, according to Faroqi-Shah and Waked (2010), the loss of writing proficiency in terms of grammar and word choices indicate expressive aphasia. In this view, his lecturers noted that Martin performed poorly in the class because he was unable to write grammatical sentences and arrange figures logically.

Tests Conducted and Results

To ascertain the condition Martin, the therapist used Halstead screening test. The therapist undertook comprehensive diagnosis using Halstead screening test by assessing verbal expression, auditory comprehension, functional communication, and reading and writing competence of Martin. The findings revealed Martin had Brocas aphasia for he had good comprehension but exhibited non-fluent characteristics with poor repetition.

The Brocas aphasia made him unable to express himself well, comprehend conversations and written texts, communicate effectively, and write coherently. According to Ogden (2005), damage to Brocas area causes a kind of aphasia called expression aphasia characterized by difficulties in communication and writing. Therefore, Halstead screening test revealed that Martin was suffering from Brocas aphasia because he exhibited non-fluent characteristics coupled with poor repetition although he had good comprehension ability.

Progress and Recovery

The aphasic condition of Martin has improved over time in response to the treatment programs he underwent. Although Martin had lost his speech and language proficiency in both communicating and writing, the therapeutic programs have helped him to improve. His friends confirm that Martin gradually regained his mental state for he has become a social and lively person. However, Martin is still struggling with speech and language proficiency because he still stammers and speaks with lisp most of the time.

According to his lecturers, Martin has improved significantly based on his academic performance. Since Martin was in the first year of his studies when he sustained the injury, he is currently completing the course successfully despite the challenges he encountered. Thus, the improvement in social life and his academic performance attest that Martin has recovered well over time.

Therapies/Treatments Used and Outcomes

Martin has undergone numerous therapies, which has enabled him to treat and manage aphasia effectively. Following the diagnosis of his condition as Brocas aphasia, the therapist put him on multimodal programs, namely, VAT, PACE, and ORLA. Martin responded well to VAT because the outcome was that he improved his communication ability through non-verbal communication. Fundamentally, VAT is a treatment approach, which focuses on improving nonverbal cues among aphasic patients (Purdy & Van Dyke, 2011).

Given that Brocas aphasia affect communication ability, PACE effectively enabled him to communicate effectively with his colleagues. The outcome of PACE was that Martin started becoming active in interacting and communicating with his friends. ORLA was used to improve visual, auditory, and writing abilities of Martin. The outcomes of ORLA were that Martin improved his academic performance. His lecturers observed that the therapy has restored his mental condition, and he was fit to continue with his studies normally. Hence, the multimodal programs effectively treated the aphasic condition of Martin within a period of six months for he was able to communicate and write fluently.

Prognosis and Recommendations

Analysis of the cause, treatment, and response to the treatment shows that Martin will eventually heal from aphasia. Since the doctors diagnosed the cause of his aphasia and employed appropriate treatment interventions, Martin will heal progressively. Plowman, Hentz, and Ellis (2011) assert that the severity of the injury and the degree of aphasia are determinants of prognosis. In this case, since the head injury was not severe and aphasia was diagnosed early, Martin will eventually recover from aphasia.

Moreover, the use of multimodal programs in the treatment of the aphasic condition boosts the recovery process. The use of VAT, PACE, and ORLA programs have proved to be effective in the treatment of the aphasic condition because of the significant positive outcomes exhibited by Martin. Therefore, for a successful recovery, Martin should undergo regular medical checkups and continue with multimodal treatment programs.

References

Chapey, R. (2008). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. Philadelphia, PA: Lippincott Williams & Wilkins.

Faroqi-Shah, Y., & Waked, A. (2010). Grammatical category dissociation in multilingual aphasia. Cognitive Neuropsychology, 27(2), 181-203.

Jordan, L., & Kaiser, W. (2013). Aphasia: A social approach. London: Chapman & Hall.

Plowman, E., Hentz, B., & Ellis, C. (2011). Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18(3), 689-694.

Purdy, M., & Van Dyke, J. (2011). Multimodal communication training in aphasia: A pilot study. Journal of Medical Speech-Language Pathology, 19(3), 45-53.

Macdonald, L. (2011). Cerebral vasospasm: Advances in research and treatment. New York: Thieme Medical Publishers.

Ogden, A. (2005). The breakdown of language: Case studies of aphasia. In A. Ogden (Ed.), Fractured minds: A case study approach to clinical neuropsychology (pp. 83-98). New York: Oxford University Press.

Salter, K., Jutai, J., Foley, N., Hellings, C., & Teasell, R. (2006). Identification of aphasia post stroke: A review of screening assessment tools. Brain Injury, 20(6), 559568

Wallace, E., Purdy, M., & Skidmore, E. (2014). A multimodal communication program for aphasia during inpatient rehabilitation: A case study. NeruoRhabilitation, 35(3), 615-625.

Wilson, A. (1999). Bill: Learning to communicate with symbols five years after a stroke. In A. Wilson (Ed.), Case studies in neuropsychological rehabilitation (pp. 149-158). New York: Oxford University Press.

Bacteria and White Blood Cells

The condition with which the woman is diagnosed causes such negative manifestation as localized kidney infection. In addition, it encompasses the work of renal pelvis as well. The signs of abscess processes are cell debris and neutrophils. The exuded substance has the potential to affect renal tubules, and white blood cells exhibit that a focal infection is present (Bostwick & Cheng, 2014). In the case of the current patient, the condition has evolved due to the response of inflammatory mediators to the bacteria. Therefore, the exudate produces urine indicative of this disease (the bacteria typical for this contagion and casts).

Differences Between Renal Failure Types

Prerenal acute renal failure is a consequence of insufficient blood supply to the kidneys, which appears due to a violation of cardiac activity (for example, due to hemorrhagic, post-transfusion shock). In the renal arteries, there is a cessation of blood flow, which causes their ischemia and leads to necrosis of tubular epithelium and the development of dystrophic changes (deWit & Kumagai, 2014). In addition, disruption of the delivery of water and sodium to the distal tubules increases the secretion of renin, which intensifies ischemia.

Intrarenal acute renal failure can develop in two ways. In the first case, immune allergic processes cause the failure of the renal parenchyma. In particular, it occurs due to circulatory disorders and various kinds of glomerular endothelial lesions. In the second case, the lesion appears due to toxic substances that act on the kidney tissue (deWit & Kumagai, 2014). Nephrotoxic substances affect the epithelium of the tubules and cause necrotic changes and their exfoliation (deWit & Kumagai, 2014). Differences in the pathogenesis of acute renal failure lie in the fact that in the prerenal form the disturbance of blood circulation has a global character, and in the renal failure  the local one.

Postrenal acute renal failure occurs due to ureteral obstruction or compression of ureters from the outside by a tumor infiltrate. Also, the cause can be an iatrogenic factor. Unlike the first two types, the postrenal form is characterized by a slower decrease in glomerular filtration (Swearingen, 2015). Therefore, irreversible changes develop within 3-4 days.

References

Bostwick, D. G., & Cheng, L. (2014). Urologic surgical pathology (3rd ed.). New York, NY: Elsevier.

deWit, S. C., & Kumagai, C. K. (2014). Medical-surgical nursing: Concepts & practice (2nd ed.). New York, NY: Elsevier.

Swearingen, P. L. (2015). All-in-one care planning resource (4th ed.). New York, NY: Elsevier.

Congestive Heart Failure (CHF) (ICD 10 Code: I50.9)

This recurrent progressive illness is diagnosed when the hearts pumping function is weakened (Hollenberg & Heitner, 2012). CHF has the following signs and symptoms: chest pain, dependent edema, orthopnea as an outcome of pulmonary edema, shortness of breath, palpitations, wheezing cough, and paroxysmal nocturnal dyspnea (Hollenberg & Heitner, 2012). The reasons why CHF may develop in elderly patients are coronary artery disease, atrial fibrillation, renovascular disease, hypertension, cardiomyopathy, valvular heart disease, and myocardial infarction.

In addition, diabetes mellitus and such a non-cardiac disorder as anemia may also lead to symptomatic congestive heart failure (Iacoviello & Antoncecchi, 2013). The predominance of CHF is higher among the elderly, especially females who suffer from obesity and/or have a history of hypertension or atrial fibrillation (Iacoviello & Antoncecchi, 2013).

Osteoarthritis(ICD 10 M15.9)

This chronic illness of joints predominantly influences cartilage. Osteoarthritis is the major reason for disability among aging people (What is osteoarthritis? 2014). The conditions that lead to patients high exposure to osteoarthritis are elderly age, belonging to the female gender, having genetic deficiencies in joint cartilage, obesity, injuries of joints, and excessive stress on joints associated with the profession or physical activity (What is osteoarthritis? 2014). Osteoarthritis is the prevailing rheumatic illness. It can also be related to cardiovascular diseases due to physical passivity and chronic inflammation. The disease is most closely associated with congestive heart failure (Sood & Sood, 2015).

Acute Renal Failure (ARF) (ICD 10  N18.9)

Acute renal (kidney) failure is a rapid or sudden deterioration in the patients renal filtration capacity. Under the conditions of acute kidney failure, a decrease in the glomerular filtration rate is noticed over a period of several days or weeks (Holmes et al., 2016). ARF may be caused by three types of effects: pre-renal, intrinsic renal, and post-renal. The first group of causes includes impaired cardiac pump efficiency, severe hypovolemia, and vascular disease that restricts the flow of blood in kidneys (Holmes et al., 2016). Intrinsic effects are presented with the hepato-renal syndrome, renal parenchymal disease, and acute tubular necrosis. The third group of causes  post-renal  includes such conditions as bilateral stone disease, radiation fibrosis, and outflow obstruction by pelvic malignancies.

The critical determinants for developing acute kidney failure are obesity, diabetes, liver disease, hypertension, atherosclerosis, and chronic heart failure. The symptoms of the disease are increased jugulovenous distention, reduced exercise capacity, recent peripheral edema, dyspnea upon exertion, hematuria, and fatigue (Holmes et al., 2016).

Ms. B. J. has the following vital signs: hypertension 150/86, R 22, and BMI 29.8. The patients symptoms are bilateral ankle and leg edema lasting for a week, lightheadedness when climbing the stairs that disappear when she sits down and rests, dyspnea, pulmonary edema, and reduced activity. Such a combination of signs and symptoms is compatible with acute kidney failure diagnosis.

Chronic Obstructive Pulmonary Disease (COPD) (ICD code 10  J44.9)

COPD is a progressive recurrent disease whose characteristic feature is the restricted flow of air to the lungs (Kim & Criner, 2013). Due to the hypersensitivity of the airways, COPD pertains both to the small airways and lung parenchyma (Kim & Criner, 2013). The signs and symptoms of the disease are a chronic cough, wheezing, fatigue, and fainting or breathlessness that intensifies during activities and reduces during rest (Kim & Criner, 2013).

References

Hollenberg, S., & Heitner, S. (2012). Congestive heart failure. In S. Hollenberg & S. Heitner (Eds.), Cardiology in family practice (pp. 91-111). New York, NY: Humana Press.

Holmes, J., Rainer, T., Geen, J., Roberts, G., May, K., Wilson, N., &Welsh AKI Steering Group. (2016). Acute kidney injury in the era of the AKI e-alert. Clinical Journal of the American Society of Nephrology, 11(12), 2123-2131. Web.

Iacoviello, M., & Antoncecchi, V. (2013). Heart failure in elderly: Progress in clinical evaluation and therapeutic approach. Journal of Geriatric Cardiology, 10(2), 165-177. Web.

Kim, V., & Criner, G. J. (2013). Chronic bronchitis and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(3), 228-237. Web.

Sood, A., & Sood, A. (2015). Prevalence of knee osteoarthritis in elderly persons in a district of Central Uttar Pradesh: A cross sectional study. International Journal of Health Sciences and Research, 5(9): 89-93. Web.

What is osteoarthritis? Fast facts: An easy-to-read series of publications for the public. (2014). Web.

In otitis media, pathogens such as fungi and bacteria affect the middle ear through the Eustachian tube. In general, the condition can last up to six weeks, with more severe cases leading to hearing issues (especially among young children). Common symptoms of otitis media include intense ear pain, fever, headache, nausea, leaking fluid from the ear, sense of fullness in the ear, buzzing, and irritability (Donaldson, 2017). During the physical exam, the otitis media is seen in the signs of inflammation in the tympanic membrane, bulging in the posterior quadrants of the tympanic membrane, the presence of thick oozing, and pain without or with the pulsation of the otorrhea (Donaldson, 2017).

Otitis externa, on the other hand, maybe caused by either infections or other factors. Swimming in contaminated water is one of the most widespread reasons for contracting the condition. Common symptoms of otitis externa include the itchy air canal, ear pain that gets worse from pulling on the ear lobe, fever, ear canal inflammation, temporary diminished hearing, and release of fluid from the ear. During the physical examination, the condition manifests through the discharge from the ear, which is initially clear, subsequently becoming foul-smelling (Waltzman, 2017).

Since young children are more prone to developing otitis (Qureishi, Lee, Belfield, Birchall, & Daniel, 2014), the differences in screening lie in the higher frequency of check-ups to make sure that otitis has been treated effectively. When assessing children, health history questions may include: Does the child attend daycare? How many prior ear infections were treated? How old was the child when the first case of infection occurred? Was the child taking antibiotics? When assessing adults, the following questions can be asked: Do you have a history of ear diseases? Have you recently performed any activities that could have affected your ears?

References

Donaldson, J. (2017). Acute otitis media. Web.

Qureishi, A., Lee, Y., Belfield, K., Birchall, J., & Daniel, M. (2014). Update on otitis media  prevention and treatment. Infection and Drug Resistance, 7, 15-24.

Waltzman, A. (2017). Otitis externa. Web.

Introduction

Health-related problems are often faced by the representatives of the general public. In order to minimalize their adverse influence on the population, professionals resort to various epidemiological methods. This field allows defining risks associated with particular illnesses or other social issues (such as smoking or violence) and their exposure. Epidemiology also provides an opportunity to identify factors associated with these problems. As a result, it provides professionals with an opportunity to control health problems.

Definition of Terms

Rather often, epidemiological methods are used to deal with those issues that reach epidemic proportions. It means that a particular population faced health-related events more than expected. In addition to that, this term can be used when a rare disease that is not common for some location occurred within it. Thus, both single and a few cases of health-related events can be discussed as an epidemic.

Similar to the term mentioned above is a pandemic. In fact, it is treated as an epidemic that affected a large population in a very wide area. It happens frequently that pandemic crosses international boundaries and turns into a global issue.

Epidemiology is a science that is concerned with the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations (Friis, 2010, p. 3). Its main goal is to control health-related issues in societies. In order to reach this goal, epidemiologists use numerous approaches, including statistical measures. All in all, this discipline gives a chance to reveal more information about health-related events so that they can even be stopped before happening.

Key Characteristics

One of the main characteristics of epidemiology is a distribution that is focused on the variation of health issues and their outcomes. As a result, it is possible to identify the most affected group of people and implement initiatives to improve their condition.

Outcomes are those consequences people face when they are affected by a disease. In fact, they reveal all the possible results. These can be illnesses caused by a particular health condition (morbidity) or death (mortality).

Quantification ensures that cases of health-related events and their outcomes can be counted. In this way, epidemiology is connected with statistics because it presupposes the use of statistical measures. They help to describe the frequency of particular outcomes and their connection with exposures (CDC, 2012).

Uses of Epidemiology

Epidemiology can be used to compare how a disease altered with the course of time. For instance, it was revealed that influenza and pneumonia were the main cause of death in 1900, but now they are in the eighth position. Epidemiology provides an opportunity to describe community health, providing annual infant mortality rates, for instance. In addition to that, it allows defining risk factors related to a particular health issue. For lung cancer, it may include a comparison of light and heavy smokers. Epidemiology can help to identify the causes of health-related events. For instance, the association between lung cancer and smoking can be considered (Friis & Sellers, 2013).

Summary

In this way, it can be concluded that epidemiology allows taking negative health-related events under control. With the help of statistical methods, it reveals associations between illnesses and their causes, risk factors, or outcomes. This field is critical for medicine because it provides an opportunity to study the history of the populations health, diagnose the whole community, assess health services, define individual risk factors, and point out the causes of illnesses.

References

CDC. (2012). Introduction to epidemiology. Web.

Friis, R. H. (2010). Epidemiology 101. Sudbury, MA: Jones and Bartlett Publishers.

Friis, R., & Sellers, T. (2013). Epidemiology for public health practice. Burlington, MA: Jones & Bartlett Publishers.

Introduction

A sore throat is one of the most common illnesses, which patients might identify and diagnose on their own. However, professional doctors are able to notice minor differences among the persons symptoms that will give him or her particular clues to another diagnosis. The following paper is intended to cover differential diagnoses that can also be considered as a sore throat.

Criteria to Meet Before the Final Diagnosis

Before diagnosing any illness, it would be proper to interview a patient in order to understand his or her major complaints and discovered symptoms or issues. Moreover, it is essential to examine a person who seeks help because a doctor is more competent and can analyze various signs of illness or disease more accurately. As it was mentioned above, it is easy to confuse a regular sore throat with more crucial issues (El-Boghdadly, Bailey, & Wiles, 2016). Therefore, three differential diagnoses will be presented below to compare them.

A diphtheria infection can be easily confused with pharyngitis because of a sharp throat ache and does not show its specific symptoms during the first two weeks of its presence within an organism (First, 2014). Another type of sore throat differential diagnosis is called epiglottitis (Lean, Arnup, Danchin, & Steer, 2014). Its symptoms usually imply such biases as trouble swallowing, voice changes, and a harsh throat (Little et al., 2014). The third possible diagnosis is a scarlet fever infection, which influences a patients headache, red throat, and other similar issues.

Conclusion

Such illnesses as diphtheria, epiglottitis, scarlet fever, and other diagnoses with similar issues and symptoms can be identified as a sore throat. Usually, patients do not consider going to their doctors because this is not a crucial disease, and they think that they are able to cure it properly themselves. Unfortunately, there are many cases of false diagnoses that worsened a lot due to an inefficient treatment. Therefore, it is always necessary to visit doctors and to adhere to their pieces of advice.

References

El-Boghdadly, K., Bailey, C. R., & Wiles, M. D. (2016). Postoperative sore throat: A systematic review. Anaesthesia, 71(6), 706-717. Web.

First, M. B. (2014). DSM-5 handbook of differential diagnosis. Washington, DC: American Psychiatric Publishing, a division of American Psychiatric Association.

Lean, W. L., Arnup, S., Danchin, M., & Steer, A. C. (2014). Rapid diagnostic tests for group A streptococcal pharyngitis: A meta-analysis. Pediatrics, 134(4), 771-781. Web.

Little, P., Stuart, B., Hobbs, F. D., Butler, C. C., Hay, A. D., Delaney, B.,& Moore, M. (2014). Antibiotic prescription strategies for acute sore throat: A prospective observational cohort study. The Lancet Infectious Diseases, 14(3), 213-219. Web.

Summary of a Healthcare Problem

Nowadays, the problems of postnatal care and the necessity to offer as many improvements and interventions as possible are frequently discussed by researchers around the whole world. Women, who have currently given birth to their children, should be ready for several changes in their lives and the necessity to complete several new duties and tasks. As a rule, in such situations, many women lose control over their lives and have to focus on their children.

Still, it is also important to remember that their personal needs, family obligations, and social relations cannot be neglected. Therefore, certain attention should be paid to postnatal care and its dependence on the incomes of families. The problems in postnatal care could be explained by poorly trained nurses and midwives, and the inabilities to clarify what kind of help should be offered to the families with newborns (Gauba, Chhugani, & Arora, 2015; Mirmolaei, Valizadeh, Mahmoodi, & Tavakol, 2014).

The current practice includes the improvements in the work of mid-level medical workers and education. Postnatal care could be offered by mid-level health workers and by high-level health workers (Lassi, Cometto, Huicho, & Bhutta, 2013). Its quality depends on not only the level of knowledge of medical workers and their abilities to help but also on the abilities of parents to analyze situations, use their knowledge, and be ready to help a child in a short period.

Besides, women have to understand how crucial participative learning could be because they could observe what steps to take when they start caring for babies, check their readiness for being mothers, and use their settings to achieve good results in postnatal care (Prost et al., 2013). Parent education is one of the main concepts in postnatal care because it involves both, mothers and fathers, and helps to create appropriate conditions for taking care of children (Khresheh, Suhaimat, Jalamdeh, & Barclay, 2011).

Postnatal care could have several forms, and mothers have to be aware of them and know when and how to ask for it. Sometimes, nurses (midwives) visit families with newborns at home. Sometimes, parents visit hospitals independently. Each method has its positive and negative sides as well as positive and negative outcomes for children and their families. The level of income defines the quality of postnatal care that could be offered to people. Unfortunately, this truth cannot be neglected. Therefore, various situations when postnatal care is offered should be investigated to prove that such interventions as home visiting, telephone hotlines, and parent education could improve family satisfaction, prevent maltreatment, and change the quality of life.

PICO Question

In low-income families who need postnatal care (P), do home visiting programs, telephone hotline services, and parent education (I) compared to usual treatment (C) influence family satisfaction, maltreatment prevention, and the quality of life (O)?

Search Strategy

The topic of postnatal care is frequently discussed by many researchers and writers. On the one hand, it is not that difficult to put such keywords as postnatal care, low income, home visit, parent education, and postnatal care interventions for the search and find several different sources. Many educational and advertising sources could be found, and general facts and information about how it means to be a mother for the first time or how to deal with parental stress are offered. On the other hand, the current research strategy requires the presence of sources with research evidence and non-research evidence. Therefore, it is important to add the required type of study to a search engine. It is better to address credible sites and consider peer-reviewed articles.

Such search engines as Scholar. Google and Medscape were chosen. Regarding the requirements of the project, about 1000 articles were found. At the same time, it was necessary to identify the time frames and choose the articles that were written after 2011. The results help to clarify that several qualitative and quantitative research methods were used by the researchers from different parts of the world to cover the topic of postnatal care, develop various interventions, and identify the challenges that medical workers, parents, and even children could have in case postnatal care is poorly organized.

People tried to discover different aspects of the topic and prove that mothers, as well as medical workers, should pay much attention to the development of the level of knowledge that was required to take care of a newborn. Research articles by Gauba et al. (2015) about the importance of training programs for nurses who offer postnatal care and Lassi et al. (2013) about the quality of services offered by mid-level and high-level medical workers helped to understand what kind of work had been already done in the chosen sphere and what contributions were expected. Such types of articles aim at discovering reviews and randomized controlled trials where people face a particular problem and find an effective solution.

These research evidence sources are numerous because people want to improve postnatal care from different aspects and make sure that the level of income does not influence the quality of care offered to mothers. Non-research articles provide the reader with the analysis of the already offered interventions, activities, and decisions. Such non-research articles like Ong et al. (2014) about the interventions that help to deal with postpartum stress among first-time mothers and Dayton, Walsh, Oh, and Volling (2015) about the types of soothing behaviors inherent to fathers and mothers of infants are used to explain what kind of help could be offered during postnatal care and what steps young people should take to succeed as parents.

The presence of research and non-research evidence sources proves that the topic of postnatal care has to be discussed and developed nowadays. There are many technological innovations and possibilities for people, and the chosen research strategy shows that researchers want to continue investigating this issue and introduce as many solutions, recommendations, and interventions as possible to make sure that medical workers including nurses, midwives, therapists, and other doctors, as well as mothers, fathers, and other members of families with newborns could understand their roles and take the steps that improve the quality of life, prevent maltreatment, and promote family satisfaction.

Evidence Matrix: Research Evidence Sources

Recommended Practice Change

Postnatal care is the type of care that should be offered to mothers and babies by experienced midwives during the first six months after birth. Regarding the current developments, technological achievements, and considerably changed patients expectations, some aspects of postnatal care should be improved, and new recommendations should be given. The current goals of postnatal care include family satisfaction, maltreatment prevention, and improved quality of life.

All these objectives could be achieved in case midwives accept the recommended practice change and understand the importance of such interventions as the development of home visiting programs, telephone hotline services, and parent education. Cooperation between midwives and parents is the main practice change that should be developed in the current project. Nurses, who have to work with mothers and their babies, have to comprehend how crucial their role to families could be. First, many mothers do not know what to expect as soon as they stay with their babies alone, and the outcomes of maternal healthy behavior remain to be unclear (Mirmolaei et al., 2014).

Besides, many parents experience stressful situations and the inabilities to live their normal lives with babies. Therefore, they think that it is normal to address midwives or even higher-level health workers and ask for professional help (Lassi et al., 2013). Still, the investigations prove that the level of medical workers does not influence the quality and variety of help. Much attention should be paid to the development of special training programs that aim at newborn care (Gauba et al., 2015), explanations of the ideas of participative learning among parents (Prost et al., 2013), and support of postnatal parent education that could be used to improve the quality of a babys life (Khresheh et. al., 2011). All these improvements and changes are possible through home visits, telephone calls, and direct lessons.

The essence of such recommendation practice change is to focus on the information that is offered to parents (mothers in particular) by midwives, nurses, and doctors. It is not enough to make sure that some lessons are given, and some brief facts about baby care are explained. Doctors have to make sure that mothers and babies have normal health indicators, nurses should check the psychological and physical condition of patients, and midwives have to clarify if mothers have enough skills and knowledge to continue taking care of their children with time.

Such conclusions cannot be made in two or even five days after birth. Therefore, home visits by midwives turn out to be one of the best practices that could be used to assist mothers, deprive them of extra doubts or concerns, and provide babies with the best care.

Telephone hotlines are also crucial for the development of communication between mothers and midwives about postnatal care. Finally, the changes in parent education are important because mothers have to know how to provide their babies with routine care, how to feed them, and how to use and change diapers. There are several mothers, who feel discomfort and uncertainty when they have to stay with their children alone. Therefore, the additional help of midwives through home visits and telephone calls could improve the level of parent education and the quality of all family members lives.

Recommendation Implementation

To promote the recommended change practice, it is necessary to understand what stakeholders should be involved in the project, to identify what barriers could occur, to develop the strategies with the help of which barriers could be overcome, and effective solutions could be offered, and to describe the indicators with the help of which it is possible to measure the outcomes of recommendations.

There are three possible groups of people, who could be involved in the decision to implement the offered recommendation in postnatal care. First, mothers have to participate in this change. They should share their opinions and experiences to create an appropriate basis for a change. Their opinions, challenges, and expectations should be identified to explain what improvements of postnatal care should be made. Another group of stakeholders to be mentioned includes nurses and midwives who have to share their knowledge about how to take care of newborns. Finally, it is possible to include social workers in this kind of change so that they could observe the results of cooperation between mothers and midwives and consider the effects of improvements offered on children and the general well-being of a family.

However, some barriers may occur in case such change is offered in the nursing practice setting. First, mothers could have different levels of knowledge about the postnatal care they have to provide their children with. Second, not all nurses are ready to cooperate with mothers when they leave hospitals. Finally, the stakeholders identified for this change may face a challenge to start cooperating. There is a need for a guide for all those stakeholders and a system to follow.

Such strategies as online questionnaires and the introduction of a coordinator could help to solve the problems and implement the change successfully. Online questionnaires should help mothers share their experiences and not be confused with the necessity to discover personal shortages in public. As soon as mothers visit hospitals to ask for prenatal care, they have to fill in special questions about the knowledge they have about child care and their readiness to take care of their children independently. As soon as the material is given by the mothers, it is necessary to find a person who could analyze the answers and think about the needs of every mother.

The idea to have a special postnatal care coordinator seems to be a good way out. In the nursing practice setting, there should be one person who investigates the conditions of mothers, their readiness to take care of newborns, and their need for additional help in the form of midwives during home visits. Such a coordinator could provide a midwife with the required portion of information about a mother and underline what kind of help should be offered.

During a home visit or a telephone call, a midwife or another medical worker has the required portion of knowledge and material that can be used. In general, two main strategies that are the development of online questionnaires and the promotion of a postnatal care coordinator could be offered in the project that should help mothers enjoy postnatal care regardless of their level of knowledge or the level of income.

To succeed in the development of this project, one indicator has to be clarified. It helps to measure the outcome related to the offered recommendation. In this case, the indicator is the level of family satisfaction that could be High, Middle, and Low. After the six months of postnatal care are over, parents should share their opinions about their satisfaction with their new status (being a parent) and the cooperation with midwives.

Low-income families could think that their inabilities to pay for extra help could influence the quality of life, family satisfaction, and even the ability to prevent maltreatment. Still, this project does not require much time to identify the needs of mothers and many people to organize the necessary portion of work. Home visiting, telephone hotline services, and the abilities to improve parent education are the main outcomes of the healthcare problem under consideration.

Several low-income families believe that their financial challenges lead to problematic and poor postnatal care. However, such concerns could be solved, and the conditions under which postnatal care is offered could be improved. Parents have to understand that their information and the abilities, to tell the truth and define personal uncertainties serve as the basis for the work of midwives. If medical workers are misinformed, the quality of help and support could be poor as well as the level of family satisfaction could below.

References

Dayton, C.J., Walsh, T.B., Oh, W., & Volling, B. (2015). Hush now baby: Mothers and fathers strategies for soothing their infants and associated parenting outcomes. Journal of Pediatric Health Care, 29(2), 145-155.

Gauba, A., Chhugani, M., & Arora, S. (2015). A quasi experimental study to assess the effectiveness of structures training program on practices of Asha workers related to new born care based on Asha module  6 skills that saves lives in a selected communities of Delhi. International Journal of Science and Research, 4(11), 2341-2345.

Khresheh, R., Suhaimat, A., Jalamdeh, F., & Barclay, L. (2011). The effect of a postnatal education and support program on breastfeeding among primiparous women: A randomized controlled trial. International Journal of Nursing Studies, 48(9), 1058-1065.

Lassi, Z. S., Cometto, G., Huicho, L., & Bhutta, Z. A. (2013). Quality of care provided by mid-level health workers: Systematic review and meta-analysis. Bulletin of the World Health Organization, 91(11), 824-833.

Mirmolaei, S. T., Valizadeh, M. A., Mahmoodi, M., & Tavakol, Z. (2014). Comparison of effects of home visits and routine postpartum care on the healthy behaviors of Iranian low-risk mothers. International Journal of Preventive Medicine, 5(1), 61-68.

Ong, S.F., Chan, W.C.S., Shorey, S., Chong, Y.S., Klainin-Yobas, P., & He, H.G. (2014). Postnatal experiences and support needs of first-time mothers in Singapore: A descriptive qualitative study. Midwifery, 30(6), 772-778.

Prost, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A.,& & MacArthur, C. (2013). Womens groups practicing participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis. The Lancet, 381(9879), 1736-1746.