Becoming a parent can be scary, especially for those experiencing it for the first time. It introduces numerous difficult decisions, with the Internet, doctors, and various experienced friends and relatives all offering different advice. One such decision has parents worldwide choosing between breast and bottle feeding or contemplating when and if it would be best to make the switch to the formula. While different studies support either one of these two feeding methods, the mixed approach of integrating both breastfeeding and bottle feeding appears to be most prominent. The following thesis proposal discusses the benefits and drawbacks of both methods and concludes the supplementary approach, where both breast and formula are used in varying proportions, to be the most beneficial one.
Many people advocate for breastfeeding as the more natural feeding strategy. There are many proven benefits to breastfeeding, including its convenience, ease of digestion, and, according to some studies, a positive effect on the babys intelligence. Furthermore, research has shown that breastfed babies are less prone to infections, such as meningitis, ear infections, and diarrhea (Ben-Joseph, 2018). Moreover, they are said to be more protected against diabetes, obesity, and various other health conditions (Ben-Joseph, 2018). Secondly, breastfeeding has shown to protect babies from overjet, open bite, posterior crossbite, and crowding, when done for at least 6 months (Thomaz et al., 2018). Thirdly, as mentioned above, one of the major arguments for breastfeeding is the skin-to-skin contact, which creates and nurtures an emotional bond between the mother and her child. The benefits extend to the mother as well, often having a positive effect on her mental and physical health.
However, there are some drawbacks to breastfeeding as well, disregarding the cases when the mother is incapable of lactating. Firstly, it can be painful for the mother, and a difficult task to get right at first. Secondly, it requires a time commitment that might be difficult for working mothers to upkeep. Breastfeeding also limits the general daily activities of the mother, including her diet, which must be strict to not cause damage to the child.
Therefore, it might seem like a better solution for some mothers to opt for the formula. With the scientific advantages of medicine and maternal care today, there are many options available in most stores. Committing to feeding the baby from a bottle allows for much more freedom for the mother and stops her from having to plan the days around the babys feeding schedule. Furthermore, as the formulas tend to be digested slower, hence there is no need for the feedings to be as often (Ben-Joseph, 2018). It can also be a relief for the woman to not have to follow a strict diet, which she had to sustain throughout the pregnancy.
Nevertheless, there are doubtless various drawbacks to using the bottle. Most importantly, the formula does not have the same amount of nutrients or the same range of tastes as breast milk (Akora, 2019). Furthermore, unlike breastfeeding, it costs money to feed the baby from the bottle. Although the prices might not be too high for individual portions, over the course of even a couple of months, they can add up to hundreds of dollars. Therefore, it can be seen as a luxury that not every mother can afford.
In conclusion, the decision of whether to breastfeed or to use the bottle is a personal one and must be made based on very subjective factors. The choice depends on the situation of the mother whether she is working, able to dedicate the time necessary for breastfeeding, or has the financial stability required to support her decision. After carefully considering all factors, the mother might make the decision to go with one or the other exclusively or to supplement breastfeeding with the formula occasionally. Whatever the decision, research is vital, and it is best to speak to a professional about the subject.
Thomaz, E. B. A. F., Alves, C. M. C., Gomes e Silva, L. F., Ribeiro de Almeida, C. C. C., Soares de Britto e Alves, M. T. S., Hilgert, J. B., & Wendland, E. M. (2018). Breastfeeding versus bottle feeding on malocclusion in children: A meta-analysis study. Journal of Human Lactation, 34(4), 768788.
In the work proposed for analysis, the primary purpose was to examine the potential association between racial discrimination that respondents may have experienced and patterns of chronic kidney disease. This study did not collect primary data on its own but used a set of 14,355 participants between the ages of 35 and 74 collected as part of a longitudinal study from ELSA-Brasil (Camelo et al., 2018). It is worth clarifying that 750 respondents who did not fit the criteria of the ongoing study were excluded from the original population provided by ELSA-Brasil (n = 15,105). The total sample was divided into four age groups (35 to 44, 45 to 54, 55 to 64, and 65 to 74), for which patterns of racial discrimination were measured according to the participants racial backgrounds. Thus, one of the main preliminary findings was the determination that black respondents in all age groups were subject to maximum racial discrimination, with this trend decreasing as age increased. In contrast, white respondents claimed significantly lower racial discrimination, and this pattern remained virtually unchanged as age increased.
Academic bias is a significant problem, affecting the quality of the results and often leading to skewed conclusions. In the paper under discussion, there are several sources that potentially downgrade the unbiased nature of the data (Pannucci & Wilkins, 2010). In particular, the authors use data nearly a decade old (from the date of publication of the paper) to form the sample, which could affect the unbiased nature of the study through changing patterns over time. In particular, it is unlikely that trends in racial discrimination could have changed over a decade, so the relationship found may be inaccurate or skewed. Another sensitivity issue in this study is the effect of historical perceptions of racial discrimination in relation to race: it is possible that being black led respondents to think that they were targets of discrimination even if they had never experienced such episodes. Finally, the study included a sample of highly educated, qualified employees and students at Brazilian universities, which implies that the results of the data analysis were biased against the general population. In other words, it could not be extrapolated to all patients who experienced racial discrimination and had a potential risk of developing chronic kidney disease.
There were several exciting findings in this study that reveal the problem of the relationship between racial discrimination and the risks of chronic kidney disease. In particular, it was stated that black individuals aged <55 years had lower mean eGFR compared with white individuals in the same age group (Camelo et al., 2018, p. 1029). Given that eGFR determines renal efficiency, this statistically significant result shows that the eGFR for black respondents was lower by 1.54 mL/min/1.73 m2 (p <.001). In other words, this result indicates an association between the racial discrimination trial for the respondents and reduced renal structure function, which supports the authors research hypothesis. A second interesting finding was that age was a significant predictor for differences in the effect of discrimination on eGFR. In both age groups (<55 and e55), racial discrimination was a significant factor for reduced renal function, but this effect attenuated as age increased. For example, for respondents who used tobacco and alcohol, engaged in physical activity, and had other chronic conditions, respondents under age 55 had about 2.38 times (p <.001) lower eGFR than older respondents with the same characteristics. It follows that age affects the relationship between discrimination and eGFR: one implication of this finding is the possible differences in respondents perception of racial discrimination depending on age; older people tend to perceive less discrimination or are less exposed to it which in turn has less effect on lower eGFR.
In conclusion, it is worth clarifying that the authors of this article did a great deal of work to identify the relationship between seemingly non-obvious variables. As it turns out, an abstract phenomenon such as racial discrimination has a direct biological effect on organismal structures, namely reduced renal activity. It follows that patients potentially susceptible to the renal disease are particularly vulnerable because they may suffer from the development of renal abnormalities if racial discrimination is evaluated. This is a phenomenal result that shows just how much socially stigmatized phenomena can affect the human body.
Worldviews are beliefs and assumptions used by a particular culture to interpret their experiences. Received, perceived, and postmodernism philosophical underpinnings have guided the practice of nursing since its inception (McEwen & Wills, 2019). Received view is mainly quantitative, and nursing as a science employs principles of objective observation, quantifying variables, statistical analysis, and experimentation (McEwen & Wills, 2019). For instance, nurses learn physiology and anatomy, established disciplines, and the medical model to inform care.
Philosophers supporting the perceived worldview place an important role of lived experiences, human interpretation, and interrelatedness in the nursing science. There is a deeper connection between an individuals experiences, values, and perspectives, and each individual has their unique experiences with many interpretation of reality (Honey et al., 2020). An example of nursing behavior is using a patients lived experiences to give hope to others.
Postmodernism regards the importance of scientific methods, and also accommodates different interpretation of reality. The philosophical underpinning has been dominant in the modern times, allowing for integration of quantitative and qualitative methodologies to improve nursing practice (McEwen & Wills, 2019). An example in nursing is critique of both qualitative and quantitative research articles as part of evidence-based practice in care of patients.
Personally, the perceived view aligns with my worldview because I understand the uniqueness of every person. The philosophical underpinning allows patients to interpret their situations differently and take control of their health better, as opposed to following one stringent truth regarding their health. Furthermore, I believe that there is no one truth. Therefore, allowing the use of lived experience can influence care of patients and health outcomes of individuals.
Dignam, Colette, et al. Moving from Do Not Resuscitate Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients. Gerontology and Geriatric Medicine, vol. 7, 2021, pp. 1-10.
This article dwells on how DNR orders could affect the process of care provision on a long-term scale. The authors claimed that the quality and frequency of CPR orders vary drastically, which may lead to reduced quality of care (Dignam et al. 4). The article is published in a renowned journal by a team of experts in the field of care provision, so the source can be deemed credible. This research article is relevant because it hints at the idea that DNR activities often overlook patient preferences and cannot be standardized while remaining medically appropriate.
Fan, Sheng-Yu, and Jyh-Gang Hsieh. The Experience of Do-not-Resuscitate Orders and End-of-Life Care Discussions among Physicians. International Journal of Environmental Research and Public Health, vol. 17, no. 18, 2020, pp. 6869-6879.
This article is important because it discusses DNR decisions and their impact on patients and their families. The majority of negative outcomes transpire when care providers ignore insights provided by the patient and their family members (Fan and Hsieh 6872). This source is credible because it explores DNR experiences through the prism of a thematic analysis of available evidence. The article is relevant to the current research project because it includes the key barriers to decision-making that may have an influence on patient outcomes on a long-term scale.
Goodarzi, Afshin, et al. Knowledge, Attitude and Decision-Making of Nurses in the Resuscitation Team towards Terminating Resuscitation and Do-not-Resuscitate Order. Ethiopian Journal of Health Sciences, vol. 32, no. 2, 2022, pp. 413-422.
This article explores the concept of CPR in relation to the need to make decisions related to the termination of resuscitation. Goodarzi et al. explore the possibilities of avoiding legal and ethical confusion when improving the decision-making process associated with DNR (418). It can be safe to say that the source is credible because renowned researchers utilized a reliable methodology to collect and analyze the data (e.g., Spearmans correlation analysis, Fishers exact, and Mann-Whitneys U tests). The article is relevant since it addresses the ethics of DNR decisions and bares the concerns surrounding the potential ways of improving DNR-related processes.
Works Cited
Dignam, Colette, et al. Moving from Do not Resuscitate Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients. Gerontology and Geriatric Medicine, vol. 7, 2021, pp. 1-10.
Fan, Sheng-Yu, and Jyh-Gang Hsieh. The Experience of Do-not-Resuscitate Orders and End-of-Life Care Discussions among Physicians. International Journal of Environmental Research and Public Health, vol. 17, no. 18, 2020, pp. 6869-6879.
Goodarzi, Afshin, et al. Knowledge, Attitude and Decision-making of Nurses in the Resuscitation Team towards Terminating Resuscitation and Do-not-Resuscitate Order. Ethiopian Journal of Health Sciences, vol. 32, no. 2, 2022, pp. 413-422.
Unfortunately, many patients die within hospital walls, surrounded by medical equipment and often with little awareness of what is happening. Many of them would like to die at home next to their loved ones. Various hospice programs and palliative care are designed not only to alleviate the suffering of critically ill patients, but also to provide spiritual and psychological assistance. It is also the nurses job to ensure that the physical and psychological needs of the dying person are met as much as possible, with all the special needs of such care.
Indeed, it is far from always possible to discharge a dying client from the hospital, because this can end his life much earlier than we would like. Old people also rarely have the opportunity to die at home, because the family usually wants to cure the sick until the last. The reason is often the inability to transport the patient safely. In addition, it is difficult and resource-intensive to ensure the safe transport of all dying elderly people.
As a rule, it is nurses who develop close and personal relationships with patients, and the nurse plays a key role in motivating the patient to participate in treatment or palliative care. This relationship helps to understand and interpret the patients feelings, desires and needs of the person who is so seriously ill. The nurse is usually the first to know about many physical and emotional problems, the first to try to solve them, and will often be the person who interacts with other team members and plans help.
As a team member, the nurse has a responsibility to work in collaboration with other professionals to solve patient care problems. They have to gather and organize facts, develop a problem-solving plan, and then execute that plan while maintaining collaborative work with other team members. However, studies note that many families are dissatisfied with the work of the personnel and their attitude towards critically ill patients (Kisorio & Langley, 2016). Nonetheless, nurses role includes psychological support of patients that could not be delivered without developing an optimistic, but at the same time, realistic attitude to the patients problems (Kisorio & Langley, 2016). It should be noted that it is very important that when helping patients at the last stage of life, a nurse must have a number of qualities, without which it is simply impossible to be close to the patient. These are mercy, kindness and responsiveness to someone elses grief, a sense of compassion and an ability to empathize.
The implementation of telemedicine is an effective means of improving the quality and accessibility of medical care in remote rural areas with low availability of medical services and a shortage of personnel since it is able to overcome territorial and temporary barriers between medical workers and patients (El-Miedany, 2017). The use of telemedicine helps to reduce the time and improve the quality of diagnostics. In addition, the number of cases of complications of diseases is decreasing, the approach of modern methods of diagnosis and treatment to the general population is approaching. This also ensures social efficiency, ensuring one of the citizens most important constitutional rights to affordable qualified medical care by expanding the volume of primary health care and ensuring its compliance with the standards of providing medical services by type and nature of diseases. Treatment is cheaper, the cost of hospital stay is reduced, the number of chronic patients and disabled people decrease.
The main format for telemedicine is the consultation of narrow-profile specialists of the personnel who assist the spot. For example, during the Brazilian fires in 2008, the main topic of telemedicine consultations was combustiology. In that case, specialists consulted local medical workers (El-Miedany, 2017). The fact is that each patient is, without a doubt, a unique case that requires an individual approach. Due to the fact that there are not very many specialists in burns, in principle, each such consultation was especially valuable. Other important areas that require telemedicine technologies are surgery, first aid for polytrauma, psychological consultations, consultations on hemodialysis, dermatology, and ophthalmology. According to the experience of the emergency services of New Orleans, it is these sections of clinical medicine that require telemedicine consultations of narrow specialists from other centers not affected by the disaster (El-Miedany, 2017). One of the essential links in telemedicine in emergencies is the consultation of primary care specialists, especially from small districts, including private clinics, where people who have suffered from the disaster turn. Thus, telemedicine can solve many problems related to providing medical care in emergencies and is essential in this area.
Mania is a mental state characterized by elevated mood, racing thoughts, excessive energy, and a decreased need for sleep. It sometimes includes psychotic symptoms such as delusions or hallucinations. Isabella suffered from bipolar mania, which has greatly affected her social life and decisions. Her husband (Hector) was shocked by some of her behaviors of wearing heavy makeup, leaving the house at night, buying a laptop for a neighbors child, and abnormal hyperactivity.
In bipolar disorder, mania may occur as part of a manic episode or a mixed episode. A manic episode is diagnosed if an individual has an abnormal high mood plus three or more other symptoms of mania. Isabella had signs and symptoms such as grandiose beliefs, engaging in risky behaviors, decreased need for sleep, and pressured speech. According to the case presented, Isabella did not sleep properly; she could not sleep for more than 2-3 hours each night for the past week. She also had pressured speech; the nurse noticed that Isabella was irritable and spoke rapidly in half Spanish and English while switching from one topic to another. Similarly, Isabella had hyperactivity since she was actively helping in community cleaning, and church and was also too focused on assisting other patients. Some of her grandiose actions included wearing provocatively and heavy makeup, which could be intended to dress impressively. Equally, Isabella involved herself in risky behaviors, such as trying to leave the house at night, which would have led to her attack by robbers.
Additionally, as a bipolar patient, Isabella needed some safety concerns that required immediate attention following her risky behaviors. One of the behaviors was leaving the house late; it can be risky for a lady to walk alone at night because there is an increased risk of being assaulted, robbed, or raped. Similarly, Isabella was overworking herself as a result of hyperactivity which could harm her because too much work exhausts the body and leads to a state of chronic stress (Sanders et al., 2017). Another safety concern is the throwing of furniture in the house; the lady is living with her husband (Hector) and her two children, aged 7 and 11 years, respectively. These young children could get knocked by the chairs thrown by their mother carelessly into the room.
Moreover, as a bipolar mania patient, I would recommend a few foods for Isabella. I would advise her to take foods that are high in protein and healthy fats, such as omega-3s, which are essential because they aid in stabilizing blood sugar levels and provide energy. In addition, I would recommend plenty of fruits and vegetables because they are high in antioxidants and other nutrients that help to protect the brain from damage. She should also avoid processed foods and sugary drinks, both of which can increase inflammation in the brain and make it harder for cells to communicate with each other. Regarding culture and communication, I would consider a few elements. Concerning culture, I will learn some of the offensive practices so as not to offend Isabella, who is already irritable. Undertaking some of Isabellas hated activities could trigger her anger (hitting someone with an object). On the other hand, I would practice direct communication since, as a mania patient, she suffers from poor judgment. Direct communication will ensure that Isabella is only executing instructions and not thinking for herself.
There are two key reasons why Isabella would have stopped taking the lithium medication. She might have stopped taking her lithium medication because she might have felt that she is no longer experiencing any symptoms. It is important to evaluate why Isabella stopped taking their prescribed medications and to ensure that the patient understands the importance of adhering to their treatment plan. Medications such as lithium are essential in helping to control the symptoms of bipolar disorder. When medication is not taken as prescribed, it can lead to a relapse in symptoms and can be dangerous for the patient (Jawad et al., 2018). In some cases, discontinuing medication without first consulting with a healthcare professional can even lead to death.
Furthermore, I will consider it important to monitor Isabellas lithium levels if the medication is restarted. I would anticipate doing a blood test to measure lithium levels in her bloodstream. This measurement will be necessary to ensure that the medication level is therapeutic and not toxic. Additionally, I will also order other lab tests, such as a complete blood count (CBC) or thyroid function tests, to screen for any potential side effects of lithium therapy. When communicating with Isabella, I will be aware of her intense and rapid mood swings and avoid topics that could potentially upset or anger her. Likewise, it is important to monitor fluid intake for patients taking lithium medication to treat bipolar mania because dehydration can increase the risk of lithium toxicity (Barroilhet & Ghaemi, 2020). Lithium toxicity can cause serious side effects, including vomiting, diarrhea, nausea, and seizures. Therefore, it is important for patients taking lithium medication to drink plenty of fluids and stay hydrated.
In addition, lithium observation medication administration is essential because it helps to regulate mood and behavior. It can help prevent or manage episodes of mania, hypomania, depression, and aggression. It is a very effective medication when used in combination with other medications and therapy. Conversely, there are essential elements for medication monitoring if Isabella resumes lithium. Firstly, the blood level of lithium should be monitored to ensure therapeutic levels are reached and maintained. Too much lithium can lead to toxicity, while too little lithium may not be effective in treating mania (Sani et al., 2017). Secondly, liver function should be observed, as lithium can cause liver damage in some people. Thirdly, renal function (kidney function) should also be monitored, as lithium can cause renal impairment in some individuals. Lastly, the signs and symptoms of overmedication, such as nausea, vomiting, drowsiness, muscle weakness, ataxia/incoordination, or under medication which includes anxiety and irritability, should be as well be checked.
Subjective and Objective Data
Objective and subjective data cues that should guide my nursing care for Isabella include:
A family history of bipolar disorder.
A personal history of bipolar disorder.
Presence of psychotic symptoms, such as delusions or hallucinations (Chaudhary et al., 2021).
History of suicide attempts.
Use of alcohol or drugs.
Unstable or rapidly changing moods (irritability, hostility, argumentative)
Sleeping too little or too much.
Provocative, aggressive, deluded, or out-of-control behavior.
Speech patterns (pressured speech, rapid switching between topics).
Maslows Hierarchy of Needs
The physiologic, safety, belonging, and self-esteem needs of Isabella can be arranged in order of priority as follows:
Physiologic needs; are the most important and need to be met first; for example, food, water, shelter, and sleep. Isabella should sleep more than 2-3 hours, as she does in most cases.
Safety needs; these entail safety and protection from danger, such as trying to move out at night.
Belonging needs; these are the feelings connected to others and a sense of being part of something larger than oneself.
Self-esteem needs; these include feeling good about oneself, having a positive view of oneself, and being respected by others. Disrespect may increase her irritability, thus leading to her committing suicide due to her poor judgment condition.
Bipolar Mania Description Process
Mania can be characterized by hyperactivity, euphoria, racing thoughts, distractibility, and poor judgment. Some symptoms of mania include: talking too fast, jumping from one idea to another, being easily distracted, fatigue, unusual talkativeness, and decreased sleep (Mayo Foundation for Medical Education and Research, 2021). They may also engage in risky behavior due to poor decisions, such as spending sprees, sexual promiscuity, and substance abuse, and becoming extremely angry or irritable. The main neurotransmitters involved in bipolar disorder are dopamine, serotonin, and norepinephrine (Siddique et al., 2018). During manic episodes, there is an excess of dopamine and norepinephrine (Coryell, 2022). This causes symptoms such as increased energy, feelings of euphoria, impulsiveness, and decreased need for sleep. During depressive episodes, there is a decrease in serotonin levels leading to feelings of sadness or hopelessness, decreased energy, changes in appetite or weight, and difficulty sleeping.
There are several tests needed for patients on lithium medication. The first test is a CBC to check for anemia, infection, and other abnormalities. The second one is the thyroid test to make sure the patients thyroid gland is working normally. The third test will be the kidney function test to ensure proper kidney functionality, as well as blood tests to measure levels of sodium, potassium, calcium, and magnesium in the blood (Devanand et al., 2018). These tests are necessary because lithium can cause serious side effects if it builds up to high levels in the body. Moreover, mania can lead to risky behavior and put the patients safety at risk. Patients in a manic state may be more likely to take unnecessary risks, such as violent outbursts, sexual indiscretions, driving dangerously, or spending money irresponsibly.
Mania Nursing Interventions
Mood stabilizers like lithium are typically prescribed to help control manic episodes (Barroilhet & Ghaemi, 2020).
Monitor electrolytes an imbalance can trigger mania symptoms or make them worse.
Provide nutritional support, including adequate protein and essential vitamins and minerals, since malnutrition can worsen mania symptoms (Lobo et al., 2020).
Encourage regular sleep and a healthy lifestyle lack of sleep and poor lifestyle habits can worsen mania symptoms.
Administer medication as prescribed by the prescribing physician; many medications are effective in treating bipolar mania, but it is important to work with a doctor to find the best medication regimen for each individual.
It is vital to monitor a person with bipolar disorder for suicidal thoughts or behaviors, especially during a manic episode.
The therapeutic range for lithium is 0.6 to 1.0 mmol/L; a lithium drug card should include information on what the therapeutic range is and how to monitor levels. Lithium toxicity can occur at levels above 2 mmol/L, so it is vital to stay within the therapeutic range (Barroilhet & Ghaemi, 2020). Above all, mild lithium toxicity includes nausea and vomiting, drowsiness and confusion, muscle weakness, as well as increased thirst and urination. On the other hand, moderate toxicity is ataxia, dystonia, tremor (trembling or shaking), and seizures; then severe toxicity is coma and death.
References
Barroilhet, S. A., & Ghaemi, S. N. (2020). When and how to use lithium.Acta Psychiatrica Scandinavica, 142(3), 161-172. Web.
Lobo, D. N., Gianotti, L., Adiamah, A., Barazzoni, R., Deutz, N., Dhatariya, K., Greenhaff, P. L., Hiesmayr, M., Hjort Jakobsen, D., Klek, S., Krznaric, Z., Ljungqvist, O., McMillan, D. C., Rollins, K. E., Panisic Sekeljic, M., Skipworth, R., Stanga, Z., Stockley, A., Stockley, R., & Weimann, A. (2020). Perioperative nutrition: Recommendations from the ESPEN expert group. Clinical Nutrition, 39(11), 3211-3227. Web.
Mayo Foundation for Medical Education and Research. (2021). Bipolar disorder. Mayo Clinic. Web.
Cerebral Visual Impairment (CVI) is directly linked to visual impairment, as it often causes issues related to vision in children across the globe. Some of the most common causes of CVI are traumatic brain injury, ischemic damage, metabolic issues, structural brain anomalies, and chromosomal aberrations (Roman-Lantzy, 2007). In the literature on visual impairment, CVI can be regarded as a neurologic visual impairment. Speaking of the prevalence of this condition, almost 7% of American children aged below 18 have been diagnosed with an eye and vision condition. Another crucial element of statistics on CVI is the growing percentage of young children who become blind or seriously visually impaired before puberty (Lehman, 2012). These children have difficulties with vision even when wearing contact lenses or glasses. Ultimately, almost half of American children with visual impairments are exposed to the damaging effects of CVI. According to Philip and Dutton (2014), developmental disabilities can be associated with CVI as well.
The evolving nature of CVI also has to be highlighted when discussing visual impairments and their impact on children. Deficits associated with complex visual tasks have to be covered when dwelling on children with high-functioning CVI (Roman-Lantzy, 2007). In other words, conventional methods of addressing visual impairments have to be replaced with innovative alternatives in order to prevent mortality and increase survival rates among preterm infants. The younger populations of children are affected by CVI because of multiple comorbid disabilities. In line with Lueck et al. (2019), there are care and learning environments that are not equipped appropriately to take on children with CVI and engage them in respective processes. Therefore, difficulties of identifying and mitigating visual impairments to prevent CVI keep prevailing, turning the latter into a global problem that has to be addressed via improved diagnosis and treatment.
Description of Blindness and Visual Impairments
The primary factor that sets the tone for the further discussion of blindness and visual impairments is that numerous therapists and teachers have never been exposed to cortical visual impairment (CVI). This means that there have to be several standard explanations that consider the occurrence of the disorder in the first place. For example, the loss of vision could be caused by visual cortex disturbances or the impact on the posterior visual pathway (Merabet et al., 2017). The majority of visual impairments can be associated with difficulties in both processing and interpreting all kinds of visual information attained by an individual. Thus, the simplest explanation for CVI would be to consider those brain-based, meaning the brain itself or certain neural pathways have contributed to the impairment (Swift et al., 2008). The problem is that the brain does not always recognize the information it receives from the eye. Therefore, issues contributing to the development of CVI could be exceptionally diverse.
As stated by Watson et al. (2007), one of the leading causes of CVI is the lack of oxygen being transported to the brain. This challenge becomes the most visible after premature childbirth and delivery difficulties. The resulting effects are often too strong to be mitigated by the human organism, with numerous links arising between a variety of conditions. For example, decreased cortical oxygen could cause increased intracranial pressure, hydrocephaly, cardiac arrest, or shunt failure (Roman-Lantzy, 2007). There is an extended list of health issues that could contribute to the incidence of CVI and worsen genetic syndromes and birth defects. Some of these infections include encephalitis, meningitis, and cytomegalovirus (Lueck et al., 2019). Congenital brain malformations cannot be ignored because of numerous sources of poisoning and drug exposure that could exacerbate CVI, such as cocaine, carbon monoxide, sedating drugs, and many other chemicals that affect humans.
Literature Review
Signs and Symptoms of CVI
There are numerous symptoms and signs that have to be considered when addressing CVI. For example, Swift et al. (2008, p. 7) suggest that visual performance in children with CVI could be decidedly variable, with students being used to turning their head when reaching for objects. In addition, poor visual attention could be attributed to students with CVI due to their gaze behaviors and the overall difficulty linked to visual novelty. This can be explained by the existence of neurological issues resulting in complications affecting the childrens motor and cognitive performance (Swift et al., 2008). Even though students with CVI could have a preference for brighter colors, they might be willing to avoid the discomfort caused by light gaze fixation. It was also noted by Merabet et al. (2017) that the visual field could be restricted in students with CVI, leading them to peripheral field loss.
Assessment Methods
The wide range of health-related effects of CVI makes it crucial to implement as many varied assessment methods as possible in order to finalize diagnostic procedures and make the further treatment process more feasible. Evidence from clinical practice suggests that detailed knowledge on the subject of CVI in children can be attained with the help of several fundamental assessments: (a) interviews and patient history interpretation, (b) assessments (formal and informal) of functional vision and visual functions, (c) observation of behavior, (d) developmental and educational skill evaluation (Philip & Dutton, 2014). Additionally, it could be important to pay more attention to the physical environment and instructional guidelines. For instance, the efficacy of diagnostic teaching could be assessed after the intervention methods have been outlined and monitored for some time by the actors responsible for carrying out the intervention (Lehman, 2012). Results of all these assessments could be utilized later to modify interventions that perform the least efficaciously and do not align against learners expectations.
Curricular Adaptations
In the field of curricular adaptations, numerous changes had to be introduced due to the advent of CVI because of the need to include vision goals for students who are engaged in active learning environments. For example, one of the primary tasks for teachers could be to establish students CVI Range scores in order to design relevant materials and plan activities in advance (Swift et al., 2008). The insight into a childs CVI Range could be helpful in terms of adapting the learning environment to the needs of every given student, depending on optimal distance, an appropriate number of visual targets, and preferred colors and visual fields. Nevertheless, curricular adaptations should remain in line with the focus of active learning in order to ensure that CVI learners are going to participate in the process (Watson et al., 2007). The increasing role of sensory input should be respected by teachers in order to pave the way for learning approaches that consider all sensory inputs with no discrimination. Consistent with Roman-Lantzy (2007), curricular adaptations for CVI should also consider latency, as both common learners and students with impairments should have enough time to plan and execute responses to the tasks offered by teachers.
Teaching Strategies
The range of strategies that could be utilized to support students with CVI is rather broad. The first element that has to be considered is the fact that teachers possess the capability to manage student behavior and predict certain actions (Lehman, 2012). Therefore, social (as per Banduras theory) and academic skills that children develop can be emphasized to hint at the weakest suits that should be addressed. A continuous process of positive reinforcement is going to help students recognize their strengths and capitalize on them while overcoming vision impairments with the help of responsible stakeholders. This is why encouragement from parents is another pillar of social and academic success attained by children with CVI. The behavior and appearance of such children should be managed carefully in order to shape their social development and grow them into respected human beings (Lueck et al., 2019). With personalized teaching strategies, it will become exceptionally easier for educators and parents to collaborate and enhance all types of skills possessed by children with CVI.
Teaching Interventions
In addition to teaching strategies, it can be essential to deploy particular interventions intended to help educators reach out to children with CVI. For instance, Swift et al. (2008, p. 10) suggest that some of the most effective interventions might be to utilize touch and vision at the same time while also capitalizing on high contrast and different movements. These effects could be achieved via the use of technology and a simplified learning environment with a vivid visual field. From appropriate lighting to response times, teachers should remain proactive in all areas of verbal and nonverbal communication with students with CVI (Swift et al., 2008, p. 10; Merabet et al., 2017). This means that tactile and verbal cues should be interconnected in order to function properly and aid teachers in employing all kinds of prompts in their practice successfully. Based on preceding experience, teachers could avoid failures while also paying more attention to the psychological and physiological state of their students.
Dorsal and Ventral Streams
The dorsal stream relates to how the course of spatial processing is carried out by the brain to transfer the information from the occipital cortex toward posterior parietal cortical areas. The dorsal stream is also known as the where of vision. Conversely, the ventral stream represents the what of vision because it projects from the occipital cortex to the temporal lobe (Ries et al., 2019). The functions associated with the ventral stream are much more often associated with impairments touching upon human development and functioning. Thus, significant alterations in either of the streams could diminish visual attention and cause children to develop photophobia (Ries et al., 2019). Abnormal dorsal and ventral streams could also predict impairments in visuospatial processing, leading to developmental and learning challenges.
Supporting a Student with CVI
The primary task that teachers would have to complete to support students with CVI is to establish complex treatment goals that require multidisciplinary methods to achieve them. The rationale behind this approach is the need to minimize the competitive demand and help the child develop skills within a friendlier educational environment (Lueck et al., 2019). Visual training should be at the forefront of the childs activity list in order to have the teacher provide all the support they can to make the learning process purposeful and stress-free. For example, Philip and Dutton (2014) suggested engaging in visual training and providing students with postural support upon request.
This task would require teachers to complete the complex preset objectives together with the child, meaning that postural support would save the childs energy and help them target visual tasks instead. Any other requirement that could be too resource-intensive should be moved to the list of secondary tasks because interventions have to provide students with a minimum amount of distress (Merabet et al., 2017). In turn, the teacher would have to ensure that every student is comfortable with their sitting position, lighting, and room temperature prior to engaging in active learning.
Another important task that is crucial for supporting children with CVI is to have the teachers include the factor of physiological and psychological health in their educational plans. According to Philip and Dutton (2014), this is a fundamental principle of helping impaired children learn because an optimum alert level has to be the time when such students engage in the learning process. The responsibility of the teacher and the childs family would be to observe the student during the day to determine the periods when they are most likely to display peak interest in engaging in various activities (Swift et al., 2008). By doing this, teachers are going to have a better understanding of when to schedule the most difficult tasks without frustrating the child. Students with impaired vision should go through predictable routines in order to achieve better personal and academic results (Lehman, 2012). Thus, the tendency of impaired students losing focus would be overrun, allowing teachers to switch between tasks at the right times to keep learners active and motivated.
Ultimately, it is not recommended to engage the multidisciplinary team at all times so that students with CVI might have a chance to work within an unrestrictive learning environment. It means that the highest levels of social and educational benefits are going to be achieved by means of teachers helping them to transfer their skills to new environments and disrupting the chains of concomitant neurological deficits (Merabet et al., 2017). Thus, a limited number of people being involved in impaired learning interventions might become an advantage in the long run. This is also true for environments where students with multiple sensory impairments have to learn, as they might remain rewarded inadequately after participating in all the activities. To overcome this issue, teachers will have to deploy active learning to launch intrinsic motivation and only select the stimuli that can be deemed as preferred by visually impaired learners (Watson et al., 2007). Nonetheless, the majority of reinforcers should be natural in order to improve the guided learning experience for children with CVI.
Conclusion
Overall, it can be concluded that students with CVI represent a problematic population that has to be addressed in order to achieve educational and assessment equity. Student behaviors have to be managed to aid teachers in terms of creating a friendlier learning environment where new skills are going to be acquired easier. Thus, interdisciplinary teams could be formed to satisfy teachers and students needs on both short-term and long-term scales. For the current research, it means that there are numerous opportunities for care and education providers to reach out to the target population and ensure that their exposure to CVI is going to become less painful. A greater level of understanding between teachers and students with visual impairments could be achieved through the interface of consistent interviews intended to disclose more vital information regarding targeted children. After having the opportunity to observe behaviors and interpret childrens interviews, teachers might be able to appeal to students capabilities by engaging them in active learning and more consistent skill evaluations. Without paying attention to the skills and needs of students with CVI, teachers are going to have a hard time adapting to impaired learners.
Nevertheless, in order to reap all the benefits and take advantage of the multidisciplinary approach, teachers will have to spend more time assessing students with CVI because their interpretations and learning abilities differ drastically. This means that a cohesive picture of a student with certain visual impairments should be created prior to the implementation of new learning strategies or theories. Speaking of the Social Cognitive Learning theory, its importance also has to be acknowledged by educators who want to master the skill of sensitive interpretation of ones behaviors and needs. The culmination of the current findings is the idea that an effective instructional program would have to be handcrafted in order to appeal to the holistic principles of teaching and unique needs of students with CVI. This is why an interdisciplinary approach can be considered the most effective means of addressing visual impairments and helping children advance both personally and academically. Overall, students with CVI represent a minority population of children who need to be assessed and observed more often than any other category of students. This is why constant support should be provided in an attempt to bring equity and knowledge.
Brucella is a bacterium that causes an infectious disease known as brucellosis. According to the Centers for Disease Control and Prevention (CDC, 2021), this microorganism, while unlikely to infect people through human-human contact, mostly derives from contact with cattle and contaminated products. The World Health Organization (WHO, 2020) states that brucellosis caused by Brucella is a globally recognized and extremely widespread zoonosis that remains one of the most neglected corresponding infections. With a global annual incidence rate of 5,000,000 to 12,500,000 cases, the fatality rate remains low and does not exceed 2% (Hull & Schumaker, 2018).
Despite its prevalence worldwide, the most recent outbreak of Brucella was in China in 2020, where after a leak on a biopharmaceutical company, more than 7,000 people tested positive for brucellosis (Yeung & Cheung, 2020). Primary predisposing factors for Brucella include the consumption of unpasteurized dairy products, working closely with cattle animals, and working at such jobs as meatpacking, slaughterhouse work, veterinarian, and lab work (CDC, 2021). Hence, it is reasonable to assume that many people are exposed to the risk of being infected with Brucella.
Safety precautions include avoiding the consumption of unpasteurized dairy products and wearing personal protection equipment (PPE) when working with animal tissues. The treatment of brucellosis is practically the same for everyone, excluding pregnant women and people with allergies to antibiotics or immunosuppression (CDC, 2021). It includes the intake of two antibiotics, doxycycline, and rifampin, for nearly two months (CDC, 2021).
The duration of treatment is extremely important, as the bacterium has an extremely high survival rate and does not produce classical virility factors (GBowacka et al., 2018, p. 151). It may be concluded that Brucella is an extremely widespread microorganism capable of catalyzing outbreaks in the areas of close interaction with animals and laboratories. Hence, it is vital to consider the risk factors and precautions prior to interacting with the aforementioned bacterium carriers.
References
Centers for Disease Control and Prevention. (2021). Brucellosis. Web.
The modern healthcare environment has changed dramatically over the past few decades. It has become an information-intensive environment and has shifted its emphasis to technological applications. As a result of these changes, efforts must be made to ensure that future health care professionals are prepared for this environment through the study of medical informatics (hereafter, MI). Modern health care is heavily influenced by advances in information technology (IT).
MI is a rapidly evolving scientific field concerned with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem-solving and decision-making in medicine and health care. MI is now integrated with all areas of medicine. Several reasons contribute to the development of this critical discipline:
The development of computing and IT;
The use of traditional paper-based methods and the importance of informed decision-making in todays health care environment (Hass & Holve & Edmunds, 2019).
The applications of MI are numerous, and each application has its potential in healthcare. Clinical informatics applications can be classified for specific patient and application knowledge depending on the type of information used (Hass et al., 2019). Patient-specific information is typically created and used for patient care in health care settings, while medical knowledge-based information is the scientific foundation.
To achieve these goals, medical education must change to meet the demands of scientific and technological advances. Significant changes that have occurred over the past few years are the direct results of advances in communication, including the expansion of the World Wide Web (Hass et al., 2019). Recently, most medical universities have incorporated the Internet as a new tool for teaching. Because of the increasing amount of medical literature available online and the reliance on Evidence-Based Medicine (EBM) medical practice, effective information management must be taught to educators and students.
It is worth adding that medical science is rapidly changing. Accordingly, medical students are facing new and unique challenges in medical practice (Hass et al., 2019). Various sources of medical knowledge arise every day. New biological discoveries, especially at the molecular and cellular levels, are also leading to discovering the hidden nature of human biology and its numerous diseases (Lovis & Madsen & Pape-Haugaard, 2020). Technology also plays a vital role in finding new therapeutic and diagnostic tools that require medical professionals to acquire more skills and knowledge. Consequently, medical education has unique opportunities and challenges that affect teaching methods, learning processes, and educational programs (Lovis et al., 2020). These factors are changing the practice of medicine and require changes in medical education in terms of form and content.
Most of todays medical students demonstrate exemplary skills in practical computer science because they can use e-mail, process texts, and search the Internet for information. However, information management in health care requires a higher level of proficiency (Bansal & Khan & Alam, 2019). Knowledge of MI will help future physicians use clinical information systems and health information resources. For example, students with positive attitudes toward ICTs mastered MI better and had higher average scores (Bansal et al., 2019). There is a meaningful relationship between medical students who are well trained in general informatics and their attitudes toward information and communication technologies.
In conclusion, it must be said that the field of health care is highly dependent on information. Consequently, it is only natural to integrate an MI course into the curriculum of medical students that will allow them to manage medical information in their future practice effectively. In addition, technology has become an integral part of health care practice during patient care. Understanding MI will help future physicians decide what they need to know and how to find what they need to know. In addition, the delivery of medical care relies heavily on the medical literature. The volume of medical literature has increased over the past few decades.
References
Bansal, A. K., Khan, J. I., Alam, S. K. (2019). Introduction to computational health informatics. CRC Press.
Hass, C., Holve, E., Edmunds, M. (2019). Consumer informatics and digital health. Solutions for health and health care. Springer international Publishing.
Lovis, C., Madsen C., Pape-Haugaard. (2020). Digital personalized health and medicine. Proceedings of MIE 2020. IOS Press.