Explain the process for delivering the (intervention) solution and indicate if any training will be needed.

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Explain the process for delivering the (intervention) solution and indicate if any training will be needed.

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:
1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
You are required to cite five to 10 sources to complete this assignment

List the methods you plan to use to assess student learning and evaluate the effectiveness of your teaching strategies (how you will determine if students met the outcome objectives).Include formative (questioning, discussion, games, etc.) and summative (assignment, test, presentation, etc.) evaluation strategies.

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List the methods you plan to use to assess student learning and evaluate the effectiveness of your teaching strategies (how you will determine if students met the outcome objectives).Include formative (questioning, discussion, games, etc.) and summative (assignment, test, presentation, etc.) evaluation strategies.

 

Teaching Plan explore the use of various forms of media and technology rich learning environments in nursing education, and discuss their advantages and disadvantages develop a teaching plan for this topic. Following the assignment guidelines below, develop and submit your teaching plan for the class period during week 6 and deliver a mini presentation explaining your teaching plan during week 7.Assignment Guidelines your teaching plan should serve as a road map of what you think students need to learn as well as how you will effectively deliver your instruction and evaluate what the students learned during the class period. Your teaching plan should guide your teaching presentation during week 7 (see guidelines for the presentation in week 7). While there are many formats for a teaching plan, the following sections should be included in your plan:The subject or topic that you plan to teach: Your topic should be selected from one of the class periods listed in your syllabus that you developed for an undergraduate nursing course.Level of instruction: The placement of the course in the nursing program curriculum (i.e., freshman, junior, sophomore, senior; beginning, mid-program, or end-of-program level)Method/mode of delivering your teaching presentation: Form of audio-visual delivery, PowerPoint presentation, or similar methodLearning objectives: Include 4–5 outcome statements that define what you expect the students to learn or accomplish by the end of the class period. Your learning objectives should be clear and measurable, and appropriate to the information you are teaching, and the level of instruction.Content outline: Develop an outline of the central points and/or skills you plan to cover. Your content should be logically structured.Teaching strategies and learning activities: List the approach, techniques, and methods you will use to drive your instruction and engage your students to reach the learning objectives (e.g., lecture, active learning, discussions). Provide a rationale supporting your selected teaching strategies, as well as their advantages and disadvantages.Plans for individual learning differences: How you plan to adapt your teaching to meet individual learning needs of various students. Explain how individuals with different learning styles will be supported by your teaching strategies and activities.Evaluation process: List the methods you plan to use to assess student learning and evaluate the effectiveness of your teaching strategies (how you will determine if students met the outcome objectives).Include formative (questioning, discussion, games, etc.) and summative (assignment, test, presentation, etc.) evaluation strategies.Include at least one written assignment and develop a rubric that clearly describes your expectations for the assignment. Your rubric should:List the criteria that will be assessed (a breakdown of the assignment parts).Include some type of scale that measures the levels of quality for the criteria being assessed (e.g., from excellent to poor, from exceeds expectations to does not meet expectations).

Natural And Conventional Medicine Health And Social Care Essay

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This paper discusses and compares the two main medical traditions – natural and conventional medicine. Both conventional and natural medicine have been practiced and found proven to hold many advantages but conventional medicine is regarded as the universal, hence, more popular method of healing illness. Conventional medicine relies on science and technology to contribute to the preservation and longevity of people’s lives and the leaps that this tradition has made has surpassed expectation. Nevertheless, with the rising cost of medicines, procedures, and hospitalization, and the preference for more holistic and non-invasive methods in the treatment of illness, naturopathy or natural medicine has grown in popularity. In its comparison with conventional medicine, this paper highlights the advantages of naturopathy including its effectiveness, safety, a good patient-healer relationship, the sense of being in control over illness, and its non-invasive nature. Naturopathy’s congruence with the culture and psychological belief systems of diverse peoples also contributes to growing preference of it. Moreover, conventional treatment has slowly incorporated natural methods such as the use of herbs, crossing over with acupuncture and other alternative practices, proving that the next best step for medicine is to maximize knowledge from both conventional and natural methods toward a better quality of life for mankind.

Introduction

In the current world, medical practice is dichotomized. Medical practice may either be classified as “conventional” or “alternative.” Sometimes, classifications go by “conventional” versus “natural” or “traditional.” These medical traditions and their respective practitioners are often pitted against one another. Yet, a closer look reveals that these classifications are arbitrary and are not actually in blanket opposition. Conventional medicine also has a long history of utilizing natural resources in the past. Meanwhile, various natural methods of healing are now using technologies too.

The real nature of these categories are hegemonic. Conventional medicine which was developed by more dominant societies and cultures arose as the dominant and in this respect, the most “scientific” way of healing. Meanwhile, indigenous, natural and traditional forms of healing that have long histories of local practices were simply lumped together in opposition to the conventional. This is similar to how various forms of traditional music have been clustered together under the banner of “world music” despite obvious aesthetic variations. Sadly, the burden of proof was pushed more to the side of the alternative or natural medical traditions.

This paper intends to give a brief discussion and comparison of conventional and natural medicine. Being the less dominant one, this paper will put stress on the strengths and positive attributes of natural medicine. Although the historical importance and contributions of conventional medicine are recognized, this paper asserts the need for a greater recognition, utilization, and further improvement in the realm of natural medicine.

Conventional Medicine

Conventional medicine, sometimes called “allopathic medicine” or even “Western medicine,” is the most widely used medical system in the world today, particularly in the Western hemisphere. It is largely based on the physical and biological sciences. Its universality lies in its materialist and standardized approaches and to its positivist and experimental tradition. The materialism of this medical school enables the easy translation of the discipline to different countries and cultures. This enables its practitioners to speak the “same language” and to have a unified view of medical problems.

Advances in the field of conventional medicine owe to its strong research tradition. Conventional treatments are all supposed to subscribe to proven treatments based on evidence. Of course, many researches are now being done by multi-national pharmaceutical corporations owing to conventional medicine’s strong commercial nature. Thus, the price to pay for getting oneself cured can be very high due to the commercialized and increasingly privatized treatment facilities, medicines and other diagnostic procedures.

Indeed, it is undeniable that conventional medicine has gone through great leaps and bounds in preserving the quality and longevity of lives of people around the world. This owes very much to advances in diagnostic and treatment procedures and preventive measures. The use of X-rays, CT scans and magnetic resonance imaging (MRI) technologies now give more accurate diagnoses over a shorter period of time. Vaccinations are now preventing the spread of diseases over large populations. Advances in the pharmaceutical industries are now presenting greater potential in curing some of the world’s deadliest diseases.

Even medical doctors (M.D.) who recognize and advocate and use alternative medicine, like Weil (1998), still point out the greater ability and efficacy of conventional medicine in treating particular diseases as compared to alternative medical systems. Particularly, they mention the management and cure of viral infections; allergies; chronic degenerative diseases; autoimmune problems such as AIDS; bacterial infection; trauma; many of the serious forms of cancer; mental illnesses, which require medication; other “functional” illnesses; and medical and surgical emergencies.

However, there are still many imperfections in conventional treatments. For example, there are drugs that are effective in treating particular problems but may bring about ugly side effects. For instance, thalidomide, a morning sickness drug is known to produce severe birth defects. The taking of malarial prophylaxis, such as doxycyclin, can damage the liver over long use, thus deemed inadvisable for usage of people living in malaria-infested areas. A recent online news report told how Americans get the most radiation from medical radiology. Viruses also evolve every day which presents continuous new challenges to the medical world.

Natural Medicine

The term “natural medicine” for the purpose of this paper refers to alternative medical systems that lean towards the usage of more natural means of healing, especially in comparison to conventional medicine. This adoption of a more simplified definition is due to the existence of several yet still similar and related definitions. The term is oftentimes almost equated to “alternative medicine” which was defined by Brannon and Feist (2007) as “a group of diverse medical and health care systems, practices and products that are not currently considered part of conventional medicine” (p. 190). In actuality, the term “alternative medicine” covers a wide array of medical systems which evolved more or less independently from different cultures. Examples are the Chinese traditional medicine, from which acupuncture and acupressure arose; Ayurvedic medicine from India, Naturopathy from Europe; macrobiotics; chiropractic and other various massage treatments from all over the world. When these methods are incorporated by conventional doctors to their practice, the treatments are termed “complementary medicine.” The clustering of these diverse medical systems and traditions, some of which from great civilizations, either under the term “alternative medicine” or “complementary medicine,” implies how the former is deemed only secondary to conventional medicine.

On the other hand, natural medicine is also treated as synonymous to “naturopathy.” Naturopathy is a cure system which targets the prevention and cure of diseases with the use of safe and efficient natural remedies (Muetzell, 2008). The practitioners’ central belief is that the human being in his normal state is healthy and that disobedience to natural laws results to illnesses (Brown, 1988). It then follows that nature has the power and resources to heal and that the human body has the ability to maintain, nurse and heal itself back to health. It is said that the movement became sufficiently coherent in Europe in the 19th century. A man named Benedict Lust, a German patient who was treated for tuberculosis through hydrotheraphy and other natural means, migrated to the United States and popularized the movement. The naturopathy movement was popular in Germany and in Britain during those days and was later popularized in the United States (Brannon & Feist, 2007).

In spite of the varying definitions of natural medicine, the various alternative medical systems named early in the paper have significant similarities in their principles, which like naturopathy leans towards the healing power of nature. The seeking of natural balance is quite universal to various traditional and indigenous medical systems. In reverse, naturopathy employs various healing practices from various cultures.

Increasing Popularity in Conventional Medicine-Dominated Countries

More and more, natural medicine has been enjoying increasing popularity and patronage in countries with advanced levels of conventional medical practice. Eisenberg et al. (1993) reported that the unconventional medicine usage frequency of the United States adult population had been way higher than stated in previous reports. Particularly, they estimated that one in three persons in the U.S. adult population had been utilizing unconventional medicine in 1990. This figure also implied a greater number of patient visits to unconventional medicine practitioners as compared to visits to conventional medical practitioners. They added that the amount spent by these adults on unconventional treatment was also comparable to the amount spent by Americans for all hospitalizations. A telephone survey in Britain revealed a 20% usage of alternative medicine, most popular of which is the use of herbs, aroma therapy, acupuncture, massage and reflexology (Ernst, 2000).

This increasing patronage of natural and other alternative medicine may also be attributed to the increasing number of physicians who practice or recommend alternative therapies to their patients. Astin (1998) mentioned how a 1994 survey showed that more than 60% of the surveyed variably specialized physicians in Washington State, New Mexico and Israel recommended alternative therapies to their patients in the previous year while 38% had done so in the previous month. Meanwhile, 47% of these physicians use alternative therapies on themselves and 23% of the physicians have incorporated alternative therapies to their practices.

The practice of naturopathy as a discipline is also becoming more and more regulated and consolidated with the creation of professional associations such as the American Naturopathic Association. More so, various schools have been accredited to teach naturopathy such as the Bastyr University, National College of Natural Medicine and the Broucher Institute of Naturopathic Medicine. More mainstream medical schools are now tackling or offering alternative medicine. Examples of such schools are Harvard, Columbia, Georgetown and Duke (Barney, 1998).

Many conventional medical practitioners critique the usage of natural medicine. According to Ernst (2003), alternative medicine is largely opinion-based. Practitioners tend to give inconsistent and different prescriptions for the same diseases or medical conditions. For example, he cites how “100 different complementary therapies were recommended for asthma, while systemic reviews failed to back up a single treatment for this indication” (p. 1134). Ernst was also disappointed at the scarcity of systematically gathered evidence. Yet, he is not against alternative medicine per se. He advocated for a more objective and scientific usage of alternative medicine.

Why the Shift towards Natural Medicine?

Overly-commercialized Conventional Medicine

Weil (1998) tells how the commercialization of orthodox medicine is discouraging patients to continue seeking conventional treatments. He characterizes how mainstream medicine continues to become more expensive and technology-reliant. He tells how the popularity of health maintenance organizations (HMOs) has gravely affected the health care system. HMOs, he claims, want doctors to see as many patients as possible for the purpose of profit. Sadly, doctors spend less time with their patients which translate to less detailed medical and family histories, thus affecting the quality of diagnosis and treatment. In contrast, naturopathic consultations involves long and thorough interview with patients. Interviews look at medical and family histories, patient lifestyle, emotional health, and other physical features.

Ernst (2000) points to various motivating factors for trying complementary and alternative medicine, which he divides into two – positive and negative motivations. Positive motivations consist of the attributes of alternative medicine itself while negative motivations refer to negative attributes of conventional medicine which pushes patients to try alternative medicine. Examples of those enlisted as positive motivation are the following: 1) perceptions of effectiveness; 2) perception of safety; 3) control over treatment; 4) good patient-healer relationship; and 5) non-invasive nature. Meanwhile, enumerated as negative motivations are: 1) dissatisfaction of- and case-to-case ineffectiveness of conventional medicine; 2) rejection of science and technology; 3) rejection of the establishment; and 4) desperation.

Education, Poorer Health Status and Congruence to Patient Beliefs and Principles

The national study of Astin (1998) revealed that the most significant factors leading to the use of alternative medicine are the attainment of a higher level of education, having a poorer health status and the greater congruence of alternative medicine to the patients’ values, beliefs and philosophies. Patrons, he said, tend to hold a philosophical orientation towards health and holism. He also found out that dissatisfaction with the conventional medical system is not as significant as the earlier mentioned factors.

Key Principles of Natural Medicine and their Implication to Treatment in Comparison to Conventional Medicine

As mentioned in Astin’s study (1998), the principles of natural medicine appeals significantly to patients. The key principles of naturologists can be summed up into six guidelines, which are: 1) Promote the healing power of nature; 2) First do no harm; 3) Treat the whole person; 4) Treat the cause rather than the symptom; 5) Prevention is the best cure; 6) The physician is a teacher, teaching patients to take care of themselves (Brannon & Feist, 2007).

Holistic (system-oriented vis-a-vis disease oriented)

The most common word to describe naturalistic treatment is “holistic.” This owes to natural medicine’s strong faith and reliance on the natural balance of nature. Particularly, the body was said to have a stable state that when bothered can lead to illnesses. Natural medicine also believes that excretion of wastes is a valuable part of this system and a stoppage to this normal functions lead to an unhealthy state. To illustrate, Chinese traditional medicine believes in the concept of “Chi,” a local concept which closely translates to vital energy. Chi, the Chinese believe, flows throughout the body. In line with this, illnesses are attributed to the blockage of this energy flow. Acupuncture for instance targets to solve this blockage.

Natural medicine practitioners look at patients in their wholeness as individuals. Practitioners usually look at factors that may be disrupting the body’s natural balance. They are not only focused on the physical body but also looks at the mind and spirit. It is common for natural medicine practitioners to look at the lifestyles of patients and tries to being out the natural healing capacity of the body. They advise and help patients incorporate stress reduction methods and healthy eating into their lifestyles.

This was in contrast to the treatment of conventional medicine which commonly isolates the physical body from the exclusion of mind and spirit (Weil, 1998). Barney (1998) a medical doctor who subscribes to medical complementation, criticizes the rigidity of conventional medicine in its approach to diseases. Particularly, he describes conventional treatments as disease-oriented. For instance, to address an infection, doctors may prescribe antibiotics that can weaken the kidneys. This shows a disregard to the body as a system only comprised of body parts. He said that treatment options must be expanded to fit the specific needs of each patient.

Regard for particularities

While natural medicine practitioners look at the “whole” in everyone, they also do not forget to look at the particular attributes of the individual. For instance, Ayurvedic medicine subscribes to the belief that there are different types of human bodies and that each body type must be given customized medical treatment. People who are fat or thin are also not automatically considered unhealthy in Ayurvedic medicine. Whereas in conventional medicine, normal body mass is calculated based on the height and weight of a person compared to universal standards. Also, some of the healthiest food prescribed by conventional medicine for a healthy person can be classified as unhealthy in Chinese medicine based on individual conditions. In this tradition, the definition of “healthy food” varies from person to person, even to those who may be classified by conventional medicine as being in a state of good health.

Bias towards the Natural

Natural medicine also attributes illnesses to actions and activities which veer away from natural laws of the body. For example, in macrobiotics, it is viewed that meat and poultry products being sold nowadays are very characteristically “un-natural” due to the hormones and chemicals being fed to the animals to facilitate speedy growth. Thus, natural medicine avoids or minimizes the usage of synthetic drugs such as antibiotics, radiation technologies, biomedical technologies such as vaccines and major surgery. Furthermore, it uses more natural substances and medicines found in the body and in the natural environment such as water in hydrotherapy. It has a far greater respect for herbal medicines which was used by a great number of people around the world. In contrast, conventional medical treatments can sometimes suppress the body’s efforts and capability to self-heal.

Conclusion

The fact that natural medicine is enjoying widening and growing support especially in the Western world gives credence to its claims of efficacy in relieving problems of the mind, body and soul. It also reflects particular weaknesses in the current conventional medical practice, which translates as negative motivations for usage of natural medicine. This validates the importance of the key characteristics of natural medicine which are: 1) holism; 2) bias towards the natural; and 3) attention to the particular. Outside the efficacy in dealing with physical problems, I think that the greatest trait espoused by natural medicine that conventional medicine lacks is in the former’s attention to the mind and body. This translates to patients’ feelings of peace, control over their bodies and feelings of being valued and respected by their healers.

Like Ernst, I believe that natural medicine and other alternative medical systems can benefit from addressing the critiques of conventional medical practitioners. In particular, it would be beneficial if natural medicine practitioners from various traditions can take steps in systematically documenting and gathering our- and other unexplored healing practices and their results. This is a positive step towards a maximization of knowledge from all over the world and the integration of various know-hows and towards more informed choices among patients.

Case Study of Cholecystitis Patient

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This assignment is based on case study one. Case study one is about a 37 year old woman called Sylvia who had been experiencing abdominal pain, nausea and vomiting. After going to the doctors; a number of tests were carried out. Sylvia was diagnosed to having cholecystitis. Cholecystitis is when the gallbladder wall becomes inflamed and the lining of the abdomen which is near to the gallbladder (University of Varginia Health system, 2008). Sylvia had to go for a laprascopic cholecystectomy because of her cholecystitis. A Laparoscopic cholecystectomy is when the gall bladder is removed keyhole, through “a small incision which is made at the naval and a thin tube carrying the video camera is inserted” (Sieglbaum. 2008). There will be a screen in theatre where the surgeon can look and see what he is doing. The surgeon also inflates the abdomen with carbon dioxide to allow him more space to perform the surgery and so that it easier to view. Another two instruments are inserted into the abdomen so that the gallbladder can be picked up. Another instrument will be inserted at another point on the abdomen “to clip the gallbladder artery bile duct, and to safely dissect and remove gallbladder stones.” The gallbladder will then be brought out of the body through the navel incision (Sieglbaum. 2008).

This assignment will focus on the post-operative care of Sylvia. Post-operative care is very important as many complications can occur after surgery and a patient may deteriorate rapidly. An example of a complication which may occur is they may haemorrhage to it is important to monitor the patients observations (Sages, 2004). The model which will be discussed in this report is

Roper, Logan and Tierney

and the nursing process will be used to express how to give the best care possible using a person centred approach. Also included in this report will be three nursing actions that are carried out post-operatively. The three nursing skills which will be included in this assignment are Observations, fluid balance and pain.


Planning and Assessing

The nursing process is a continuous process that assesses the patient’s needs and looks at the patient holistically. The nursing process goes round a continuum which is Assess, Plan, Implement and Evaluate this is a continuous process. This is important as any patients need’s can change frequently. An assessment framework can then be put in place using model such as Roper Logan and Tierney (2003). This specifically looks at meeting the patients’ need the nursing staff should have a wider view of how to care for the patient and the patient should be treated as a whole person. The NMC code of conduct (2004) states that you must respect and treat the patient as an individual. This means we have to look at the different areas that make up the patient – their feelings, body and mind this gives us the base of holism (Siviter. 2007, p. 41). The Roper Logan and Tierney model had 12 Activities of daily living the factors which influence these are biological, psychological, sociocultural, and environmental and politicoeconomic. The 12 Activities of living are: Maintaining a safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying all though each of these activities are separate in there own way they are also linked to each other; for example you can not eat and drink without elimination or breathing (Roper, Logan and Tierney. 2003, p. 13). These activities are important for Sylvia. Sylvia has had surgery so may be facing some problems/potential problems. A care plan has been constructed using the nursing process and 12 activities of daily living to enable nurses to work better as a team and be more away of problems that may occur for Sylvia. In addition to this care will be of a higher quality if the nursing staff are following the same care plan. This care plan is specific to Sylvia and should be reviewed regularly as changes will need to be made as Sylvia will hopefully progress and soon be well enough for discharge home (Appendix 1).The 12 activities of daily living affect every patient as to whether they are meeting them or not. They will affect them at different levels. Sylvia’s day to day lifestyle will be affected by her surgical procedure that she has had to remove her gall bladder because of the cholecystitis. The 12 activities of daily living were used to assess Sylvia when she was admitted to set up the care plan. When assessing any one patient we can ask questions or observe them, however asking the patient questions isn’t always a reliable as they may not tell you the whole truth or for pain everyone’s perception of pain is different. Also when observing someone they may feel conscious of you observing them so will possibly act differently. To provide Sylvia with the best care possible nurses would concentrate more on some activities of daily living than others. These would include: Maintaining a safe environment, communication, breathing, eating and drinking and mobilising.


Maintaining a safe environment

In hospital maintaining a safe environment is key for both the patients and the visitors. It is important that you use the correct equipment for patients to prevent any hazards or injury for the patient in particular. One which is assessed on admission is the waterlow score this score takes into account many factors too see whether the patient will require a special mattress e.g. air mattress to prevent pressure sores. The waterlow score is one that is often missed along with the must score when the patient is being admitted and often nurses forget to reassess (Waterlow, 2008). When a student nurse was on placement an audit was carried out to see how well the waterlow and must scores were being recorded, the result of this was poor as it had not been getting assessed in the patients notes; it is important to prevent pressure sore and make the patient as comfortable as possible. Wards should be getting 100% as it is important to give the best care possible to every patient to do this they need to be assessed regularly; this is a prime example of were the nursing process should be used. Sylvia may be at risk of falling out of bed due to anaesthetic so nurses should put the cot sides up on the bed. If Sylvia’s surgery had gone to open surgery when she returned to the ward she should be in a side room to prevent her wound from being at risk of getting infected or contracting MRSA.


Communication

Communication between staff and patients is extremely important, so that the patient knows what the plan is and can start to build trust in the staff. The more trust the patient has in the staff the more likely they are to ask questions and feel less embarrassed. “Humans are essential social beings and spend the major part of each day communicating with other people. The activity of communication is therefore an integral part of all human relationships and all human behaviour” (Roper, Logan and Tierney. 2003, p. 19). This shows that communication is the most important activity of living as without communication it would be impossible to give or receive information. When Sylvia is first out of theatre she will be unable to communicate fully due to the anaesthetic, so it is important to closely monitor her to make sure that there is no problems occurring. When Sylvia arrived back on the ward, the staff that was with her in the recovery room would handover how the operation and her recovery had gone so far. Communication can be both verbal and non-verbal. For example Sylvia had a sore abdomen after the operation she may have had her hand over it and her facial expression may have been expressing pain. When Sylvia was getting ready to be discharged home, when she got up she went pail and was feeling faint and was advised to stay in overnight. The nurses would have to get in contact with someone such as social work to arrange care for Sylvia’s children. “Good communication among professionals in the post operative period is essential” (Gibson 2006 p 936). It is useful if the nurse has back ground knowledge on the procedure as the patient may not understand some of the doctor’s terms.


Breathing

Breathing is fundamental to every human being. “Breathing seems effortless and people are not usually consciously aware of the AL of breathing until some abnormal circumstances forces it to their attention” (Roper, Logan and Tierney. 2003, p. 22). Sylvia was being assisted to breathe with the aid of oxygen therapy after her operation. The organs of the respiratory system provide cells of the body with oxygen through the external and internal respiration process. To allow this to work, “the blood, together with the vessels and organs compromising the circulatory and lymphatic systems, is also required.” We need both the “respiratory system and the cardiovascular system” to allow us to breathe (Roper, Logan and Tierney. 2003, p. 22). Nurses can encourage Sylvia to deep breath which will expand the lungs and clear the anaesthetic.


Eating and Drinking

“Eating and drinking play a significant part in the everyday living pattern of all age groups, and for most people they are pleasurable activities” (BUPA, 2009). If an individual in unable to eat for reasons beyond their control they may be given a nasal gastic tube and fed through this and given IV fluids. Eating and drinking is essential to stay alive, without food and drink you would die. Eating and drinking also helps in the healing process. Protein and vitamins which we get in some food will help wounds to heal more quickly and also glucose for energy. It is also important to keep hydrated so that the wound heals quicker (BUPA, 2009). So this is vital after an operation when able that Sylvia eats to help heal her wound areas that she will have. If Sylvia does not eat and drink the wound will take longer to heal and will increase the risk of infection.


Mobilising

“The capacity for movement is a characteristic of all living things and the ability to move the body freely is a necessary and much valued human activity” (Roper, Logan and Tierney. 2003, p. 38). Sylvia’s mobility may be limited due to the cholecystectomy and anaesthetic; because Sylvia’s operation was laparoscopic her wound will heal quicker so she will regain full mobility quicker. If Sylvia needs the toilet quite soon after the operation she may need assistance as she will still be under anaesthetic. This may be embarrassing for her so it is important to maintain privacy and dignity. When Sylvia returns hope caring for her children may prove quite difficult as she will not be able to lift them. She will require some assistance with this from family or friends. If there is no one who can help her, the nurses can get in contact with the social work to see if she can get help with her children while recovering. Sylvia needs to take care when caring for her children because of her wound.


Nursing Actions

Nurses have to carry actions out to make sure that everything is going in the right direction for Sylvia and if there are any problems they can deal with them quickly.


Observations

When Sylvia arrives back to the ward from surgery it is very important that a nurse checks ABC (Airways, Breathing, Circulation) immediately and continues to monitor this. If Sylvia is alert and conscious this is a good sing that she has an airway and that she is breathing, if Sylvia is warm and good colour e.g. not blue or grey and her heart rate is within the average rate her circulation is good. The nurse may also press on the finger nail to see how quick it goes from being white to red this is to see how good the capillary refill is. If it is good it should change from white to red within 2 seconds. If it had taken longer than two seconds to change back this may be due to dehydration, shock peripheral vascular disease or hypothermia (Dugdale, 2009). When Sylvia arrived back on the ward all the nurses would be given a handover to say how the surgery had went and if everything had gone as planned. On Sylvia coming back to the ward her observations must be checked. Sylvia will be on a SIRS chart since she has been to theatre. The observations on this are (Blood pressure, temperature, respiratory rate, Spo2 level, heart rate, urine output pain score and PCA (patient controlled analgesia). The normal/average ranges for each of these observations are:

Blood pressure – “100/60 – 140/90” (Marieb and Hoehn 2007, cited in Dougherty and Lister 2008, p.622)

Temperature – “36-37.5oC” (Tortora and Derrickson 2008, cited in Dougherty and Lister 2008, p.656)

Respiratory rate – “15-20” (Weber and Kelley 2003, cited in Dougherty and Lister 2008, p.613)

Spo2 level – “95%-98%” (Woodrow 1999, cited in Dougherty and Loster 2008. P.648)

Heart rate – “55-90” beats per minute (Weber and Kelley 2003, cited in Dougherty and Lister 2008, p.613)

Urine output – “>1803 ml/6hr” (Gibson, 2006 pg922)

Sylvia’s observations will be checked regularly: “every 15 minutes for the first hours, every hour for the next 4 hours and every 4hours for the next 48 hours” (Lippincott Williams & Wilkins, 2007 pg 379). The every 15 minutes checks will be done in the recovery room rather than it the ward. Looking at Sylvia’s observations on returning to the ward her blood pressure was slightly high – 145/90, respiration rate was also high at 23 per minute as was heart rate at 100 beats per minute, because of Sylvia’s high heart rate and high respirations we have to monitor her closely because if her blood presser was to be low that would be a sign haemorrhage. Sylvia had a high pain score of 7/10 this score is based on 0 being no pain and 10 being unbearable. Sylvia was given Morphine to try and relieve the pain that she had. It is important to ask Sylvia about nausea as many patients do feel nauseous after surgery this may be because the surgery is in the abdomen area or because of the drugs used for the general anaesthetic this includes anaesthetic gases.(Selby, 2006). Sylvia was prescribed Ondansetron for nausea.


Fluid Balance

Before Sylvia went for surgery she would of have to have fasted. Post-operatively Sylvia would be on a fluid balance chart. SIGN 2004 states that “the principles of fluid balance” after a patient has had an operation are:

” to correct any pre-existing deficiency

To supply basal needs

To replace unusual loses…

To use the oral route where possible; there is often an unnecessary delay in commencing oral intake after surgery” (SIGN, 2004 pg 28).

Sylvia may be dehydrated due to having been fasted. She may have IV fluids running which would have been prescribed by the doctor and put up and checked by the nursing staff. About 52% of a female’s body weight is fluid in the body. A loss of fluids can case major effects. If there is as little as 10% loss it can cause death, 8% illness and 5% thirst (Carroll, 2000). This shows how important it is to monitor Sylvia’s intake (IV fluids, oral fluids when able) and out take. (Urine, Fluid from drain site, feces, vomit and sweating but this would be impossible to measure). This should be recorded hourly. Unusual loses such as fluid from the drain sight needs to be replaced. This may be done with IV fluids. When Sylvia returned to the ward she had not passed urine, if this continued she would have to be catheterised but fortunately she passed urine at 6pm. The stress of the surgery may have caused strain on the kidneys and could be the cause of the delay in excretion of urine. This would have been measured and recorded on the fluid balance chart. Sylvia would possibly have a drain from her wound so it is also important to record the volume of fluid that is coming from the wound. There was no sign of soakage from the wound site when she returned to the ward which is a positive sign. This should be continuously monitored. At the end of each night everything that Sylvia has taken in has to be added up and her total out put needs to be taken away from this to see if she has a positive or negative fluid balance.


Pain Assessment and how to control pain

Patients are often very concerned about what their pain level will be after surgery (Gibson, 2006 pg 929). Many patients often expect to feel pain postoperatively and are show that they are satisfied even if the pain is still present. (Sherwood et al 2003, Cited in Gibson, 2006 pg 929)

There are many pain assessments that can be used. Every patient is an individual and perceives pain differently. What is a pain score of 5 may be a pain score of 8 to someone else. When Sylvia returned to the ward the nurses used the pain assessment of asking her what her pain was on a scale of 0-10 with 0 being no pain and 10 being unbearable. Sylvia’s pain score was 7/10. This is quite a high pain score. The doctor reviewed Sylvia and prescribed 2.5mg of Morphine to be given by subcutaneous injection. According to the BNF (2007) the dosage Sylvia was prescribed is adequate to start with as the maximum dosage is “10mg every 2-4 hours if necessary” (BNF, 2007 pg 228). Morphine is a controlled drug so has to go through the controlled drug book and has to be checked by two registered nursing staff. If Sylvia’s pain was to continue the doctor may decide to give her a PCA to control the pain. A PCA is Patient controlled analgesia and is given through the rout of IV. Sylvia would have a button that she would be able to pres when she felt she required something for the pain. The patient is unable to overdose on this as the machine has a lock on it and will only allow the patient to press the button for example once every five minutes. The amount of medication the patient has used from the pca is recorded on the observation chart. On the machine it will also tell us how many good attempts Sylvia has had and how many bad. If there is a lot of bad this means that her pain must be bad and she is pressing the button more often than she is allowed. The doctor would have to review this (Macintyre, 2001).


Conclusion

To conclude this assignment it is important to work as part of a team and communicate with the multidisciplinary team to give Sylvia the best care possible. It is important to treat the patient holistically. In addition to this, this assignment shows how the nursing process works and how it can be used along with Roper, Logan and Tierney’s 12 activities of daily living. It shows how well the use of the activities of living fit in with the nursing process in making a care plan.

Basic origanizational and systems leadership for quality care and patient safety (see the AACN Essentials of Baccalaureate Education for Professional Nursing Practice for more information), and discuss how it meets these essentials.

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Basic origanizational and systems leadership for quality care and patient safety (see the AACN Essentials of Baccalaureate Education for Professional Nursing Practice for more information), and discuss how it meets these essentials.

 

E-Portfolio- Instructions

Select one piece of work from this course that best represents essential II basic origanizational and systems leadership for quality care and patient safety (see the AACN Essentials of Baccalaureate Education for Professional Nursing Practice for more information), and discuss how it meets these essentials.

ASSIGNMENT CHOSEN IS (CREATIVE IMPLEMENTATION LEADERSHIP)- ASSIGNMENT ATTACHED

Points possible

Criteria

Selected work clearly ties in with appropriate objective or Essential
Discussion consists of 2-3 well developed paragraphs

APA format, including correct spelling & grammar

https://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

https://www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf

What does it mean to be a change agent? Give two examples of when you were a change agent or witnessed another nurse as a change agent.

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What does it mean to be a change agent? Give two examples of when you were a change agent or witnessed another nurse as a change agent.

 

Engaging in a political process enables a nurse leader to influence others in order to achieve a set of professional goals. Conduct extensive research on the importance of political process in nursing, and answer the following questions:

How can average nurses be involved in the political process?
What do you do or should do in order to become more politically active?

Discussion Question 2

Effective leadership can help nurse leaders to bring about a desirable change within the system. Using the South University Online Library or the Internet, gain adequate insight into change theories and change management, and answer the following questions:

What does it mean to be a change agent? Give two examples of when you were a change agent or witnessed another nurse as a change agent.
What happened and how did the change occur?

Severe Sepsis and Septic Shock: Management and Performance Management

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SEVERE SEPSIS AND SEPTIC SHOCK: MANAGEMENT AND PERFORMANCE IMPROVEMENT

Referring to the Medical Surgical Textbook by Brunner and Suddarth’s 14th Edition, “Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection” (Pg. 313). Sepsis may also be referred to as “blood poisoning.” It often leads to organ failure or injury. Sepsis progresses to septic shock when the blood pressure drops instantly leading to inadequate tissue perfusion and this could lead to death. This article explains etiology, signs and symptoms, diagnostics, treatment, prevention, management and use of various approaches to improve sepsis outcome in the healthcare system.

Schorr, Zanotti and Dellinger’s article explains how large variability in clinical practice including creation of awareness that certain processes of care associated with improved critical care outcomes, has led to the development of clinical practice guidelines in a variety of areas related to infection and sepsis

.

This leads to early detection of sepsis and septic shock signs reducing the mortality and morbidity rate. Nurses are a critical part in the healthcare system given that they interact more with the patient. By close monitoring with collaboration of other team members such as the physicians, nurse technicians, lab technicians there can be prevention, identification and early treatment of sepsis especially for the hospitalized patients because of their compromised immune system.

Very young/old patients, diabetes/cirrhosis patients, patients with wounds/burns and those with invasive devices like catheters are more prone to sepsis. Bacterial microbes are the most common causative organisms though manifestation can also be seen with fungal, viral and parasitic infections. Genito-urinary, respiratory and the gastrointestinal systems are the most common sites of infection. Sepsis is the leading cause of death in non-coronary ICU patients with infections including those of the skin, lungs, urinary tract infections and abdomen directly affecting the bloodstream. Patients with this type of infection need immediate aggressive care that is often treated in the Intensive Care Unit because progression may result to multiple organ failure and finally death.

Critical Care and Reviews

states that “Multiple organ failure is a sepsis complication that results when there is a prolonged systemic hypotension, disturbed perfusion of the circulation that cannot be effectively restored and direct tissue toxicity hence contributing to the failure of multiple vital organ systems.

Fever is the first manifestation of sepsis while pneumonia is the common presentation leading to sepsis. Other manifestations include; tachycardia, tachypnea and diaphoresis. Late signs include; Dizziness, loss of consciousness, confusion slurred speech, shortness of breath, clammy and cool skin and paleness especially on extremities.

ATI Medical Surgical Nursing Textbook states various ways that can be used to diagnose sepsis includes; ECG, Electrocardiogram, CT Scan, Cardiac catheterization and chest x-ray. Some of the lab tests that can be used includes; ABGs, serum lactic acid, serum glucose and electrolytes which increases during shock.

There are various ways used to manage sepsis/septic shock. In cases of severe sepsis, immediate clinical treatment is needed or call 911. Before any medical management is initiated, the underlying cause is first identified so that it can be corrected to avoid progress to shock. Initial resuscitation which includes goals within the first 6 hours are initiated. Fluids replacements such as IV fluids and medications are administered to maintain an adequate blood pressure to have an adequate tissue perfusion. Broad-Spectrum antibiotics are initiated, and blood cultures are collected before administration. Vasopressin therapy is also initiated in severe cases in case the patient remains hypotensive.

Nurses are required to continuously monitor the tissue perfusion and administer oxygen supplements if needed. Transfusion of packed red blood cells in cases of severity and monitoring hemodynamic status is also crucial. Nurses should also give brief explanations about diagnostics, treatment procedures and outcomes. This helps to ease stress and reduce anxiety to the patient and the family. Promote safety by preventing falls, close monitoring and frequent reorientation.

Nurses should educate the patient on proper handwashing techniques to avoid other episodes of infections that may cause sepsis. Educate patients on getting recommended vaccines example; influenza, pneumococcal. Clean skin wound properly; a wound care nurse may step in to make sure the wound has totally healed with no complications. Practice oral hygiene to prevent teeth infection that may cause sepsis, follow up with the doctor’s appointments and total compliance with the medications.

It is only with early diagnostics and expedited treatment can sepsis morbidity and mortality decrease. According to research proper utilization of the sepsis guidelines has helped improve septic shock severity. However, as sepsis remains the leading cause of mortality worldwide, additional studies are needed to determine the most effective way to achieve sepsis bundle targets, including the incorporation of nurse-led screening and treatment protocols.

Reference

  • Assessment Technologies Institute (ATI) Nursing Education. (2016). ATI content mastery series: Medical Surgical, Review module edition 7.0.  Assessment Technologies Institute, LLC.
  • Hinkle, J. L & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th Ed.). Philadelphia: Wolters Kluwer
  • Rossaint, J., & Zarbock, A. (2015). Pathogenesis of Multiple Organ Failure in Sepsis.

    Critical Reviews in Immunology,35

    (4), 277-291. doi:10.1615/critrevimmunol.2015015461
  • Schorr, C. A., Zanotti, S., & Dellinger, R. P. (2014). Severe sepsis and septic shock Management and performance improvement.

    Virulence

    ,

    5

    (1), 226. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edb&AN=93549802&site=eds-live&scope=site

Preventing Healthcare Associated Infections (HAI)

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Introduction

Clinical governance is important for providing safe care to patients and is essential to continuous improvement in patient safety.(vicgov) One of the key components in relation to this safety and quality issue in health care is preventing and controlling healthcare associated infections(HAI) which plays a significant role in poor outcomes of patients.(sahealth) To prevent transmission of HAI, Hand Hygiene should be done which is one of the most effective ways. Clinical professionals, especially nurses who have high risk of HAI transmission to patients, need to review the effects and great importance of Hand Hygiene to minimize the risk of HAI. Also, study tells that a number of infections can be prevented by adherence to established infection control practices.(sahealth) However, when accessing articles, they need to know the review methods such as a systematic review and randomized control trial, to satisfy evidence based practice with having analysing skills for quality resources. Five articles were reviewed to practice this.

Critique

Larson et al did research to examine the impact of the new practice Guideline on HAI and this compared the infection rates of pre- and post-Guideline implementation in a sample of US hospitals in different time. The problem is the result can be affected by time. Some components, such as how surveillance is conducted, how infections are defined and other concurrent infection prevention activities over time, might play a significant role in the result. Also, there were no control groups in this research so that the outcome of this research cannot be compared with the control group’s infection rates in the same time of post-Guideline implementation. And there was only 2 days observation which is unlikely to be an accurate reflection of practice.

Monistrol et al used no control group as well. And Hand Hygiene compliance, the consumption of alcohol-based hand rub (AHR), HAIs and MRSA hospital acquisition incidence were measured. Hand Hygiene compliance was measured by direct observation of health care workers during daily work routine. Observations covered all the 8 hour shifts on weekdays, which is more acceptable than Larson et al’s only 2 days observation. However, infection control nurses undertook the observers and also part of the educator. This could explain the high Hand Hygiene compliance in all periods due to the presence of observers.

Meanwhile, Allegranzi et al assessed the effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country, evaluating hand hygiene infrastructure, compliance, healthcare workers’ knowledge and perceptions, and handrub consumption.

The ideal design for these researches would be Randomized Clinical Trial (RCT), because the research outcomes can be compared by control groups for more exact data in a same time. However, those cannot be done properly with RCT and this is the reason why they did not choose RCT for the research strategy. Once the new practice Guideline is published, the control groups will be informed as well. And this might withhold best practices from patients, raising ethical concerns.

The most rigorous study among those three articles was Allegranzi et al’s research. To examine the effectiveness of WHO’s hand hygiene improvement strategy, they prepared well with training the observers for a long time according to the WHO observation method. And for the baseline evaluation and follow-up evaluation WHO knowledge questionnaire was administered. Also, more scientific and specific categories such as hand hygiene infrastructure and healthcare workers’ level of knowledge were shown in this research than others.

Stout et al and Melissa et al reviewed articles by using a systematic review. In regards to the search strategy, Stout et al searched only PubMed for relevant articles. While Melissa et al searched MEDLINE, EMBASE, CINAHL, HMIC, the Web of Science and the Cochrane Library databases. There is evidence that single electronic database searches lack sensitivity and relevant articles may be missed if only one database is searched(Akobeng 2005). Meanwhile, Stout et al evaluated and reviewed 3,463 articles published between January 1, 2000 and March 31 2013. Forty two articles were selected and grouped into 1 of 4 categories after quality assessment of articles. Also, the earliest year of 2000 was selected because alcohol-based hand rub was not widely in use in prior years. This is a quite scientific strategy. While, there was no specific reason for Melissa et al to pick the articles between May and November 2004, as well as there was no mention about quality assessment of studies.

A systematic review was selected for these articles to examine primary studies on focused clinical questions so that specific answers from narrowly defined review questions were given.

Findings & Conclusion

The result of Larson et al indicates that hand hygiene guideline was disseminated and hospitals responded by modifying procedures and policies, compliance with hand hygiene recommendations remained low. Similarly, Monistrol et al suggested that no changes in incidences of HAI were shown after the multimodal campaign. However, Allegranzi et al found that hand hygiene improvement is affordable and effective in a healthcare setting with limited resources. The difference between

Summary


Number
Author/s, year country
Aims
Sample/setting
Design/methods
Main Findings
Strength/limitations of the study
1 Stout, Ritchie & Macpherson

2007

UK

 To improve compliance with hand hygiene guidelines, resulting in low incidence of HAI. Search strategy with combined terms of ‘handwashing’, ‘alcohol cleanser’, ‘infection’, or ‘compliance’

Date or language limitation were applied.

 A systematic review: MEDLINE, EMBASE, CINAHL, HMIC, the Web of Science and the Cochrane Library databases between May and November 2004
2 Melissa et al

2014

US

 To assess the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings.
3 Allegranzi et al

2010

US

 To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. University Hospital, Bamako, Mali Introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Compliance increased from 8.0% at baseline to 21.8% at follow-up
4 Larson, Quiros& Lin

2007

US

 To evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention(CDC) Hand Hygiene Guideline

To compare rates of HAI before and after implementation of the guideline recommendations

To examine the patterns and correlates of changes in rates of HAI

 Survey for 89.8% of 1359 staff members

Hospitals that were members of The National Nosocomial Infections Surveillance System

 Quantitative study during 2001 – 2004, Hand Hygiene Guideline implementation and compliance measures: the introduction of the guideline within the hospital; the presence of the recommended products on clinical units; institutional policies and procedures regarding hand hygiene, includeing the presence of a formalized plan to monitor compliance.

Measure of HAI pre- and post-Guideline: collecting data regarding HAI rates in the ICUs of study hospitals for 12 months before and 12 months following publication of the Hand Hygiene Guideline.

 Hand hygiene compliance: ranged from 24% to 89% per ICU

None of the pre to post-rates of change were associated with hospital characteristics.

 Assessment of hand hygiene compliance was based on just 2 days of observation
5 Monistrol et al

2011

Spain

 To evaluate the effectiveness of a multimodal intervention in medical wards in relation to hand hygiene compliance, alcohol-based hand rub consumption and incidence of HAI and MRSA. 825 patients and 868 patients totally in the pre and post period respectively. Conducted at three internal medical wards(113 beds) in Hospital Universitari Mutua Terrassa, Spain Quantitative: Prospective study during 2007 – 2009. Carried out in four phases: a baseline phase(10 weeks from February 2007), an intervention period(5 months from June 2007), a post intervention(10 weeks from November 2007) and follow-up evaluation(November 2009) Hand hygiene compliance improved from 54.3% in the pre period to 75.8% in the post period.

Alcohol-based hand rub consumption increased from 10.5 to 27.2L per 1000 patient-days.

The incidence density of HAI ranged from 6.93 to 6.96 per 1000 hospital days and new Healthcare Associated MRSA went down from 0.92 to 0.25 per 1000 hospital-days.

 Strengths: conducted in general medical wards with the long-term follow-up

Limitations: no control group was used; no group session, compliance observation or surveillance of HAIs was carried out outside the studied area

Vic gov


http://health.vic.gov.au/clinrisk/publications/clinical_gov_policy.htm

sahealth


http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/safety+and+quality/preventing+and+controlling+healthcare+associated+infections

Impact of the Cardiac MRI on the Diagnosis of Heart Failure

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Discuss how cardiac MRI has revolutionised the diagnosis of human heart failure.

Magnetic resonance imaging (MRI) techniques endure as an evolving clinical tool, providing intricate and comprehensive assessments of anatomical and functional variations in the diagnosis of various injuries and ailments. Particularly, cardiac MRIs have evolved as a revolutionary imaging modality in providing non-invasive, high quality, cross sectional images that enable for precise anatomical delineation in the diagnosis and monitoring of human heart failure (Peterzan et al., 2016; Karamitsos et al., 2009). In considering family history and the onset of any exercise induced symptoms mimicking heart failure, cardiac MRIs are performed as a frontline gold standard method to collate numerical measurements relating to ejection fraction, heart muscle thickness and overall heart size (Kanagala et al., 2018; Stokes et al., 2016). These can in turn identify coronary heart disease, heart attacks, cardiomyopathy, congenital heart disease, diabetes, hypertension, arrythmia, renal disease and obesity as implicated in heart disease. In doing so, cardiac MRIs assess the central changes evidenced in patients with heart failure and provide a revolutionary diagnostic ability. In providing a non-invasive internal view of precise anatomical and functional delineations, cardiac MRIs allow for a revolutionary characterisation and diagnosis of heart failure that other imaging modalities lack.

The strengths and limitations of cardiac MRIs will initially be discussed in underpinning the revolutionary role of various cardiac MRI techniques in the diagnosis of human heart failure. Subsequently, case studies will be utilised to explore the additive nature of cardiac MRIs in clinical settings to imaging modalities such as cardiac CT scans, echocardiography and X-rays. The sole use of cardiac MRIs will also be analysed in the diagnosis of heart failure. Finally, the move from obtaining qualitative diagnostic information towards more refined quantitative assessment methods of imaging will be explored in further emphasising the central role of cardiac MRIs in the diagnosis of heart failure.

The revolutionary role of cardiac MRIs is most significantly attributed to the precise delineation of anatomical structures which accordingly allows for various qualitative and quantitative assessments to be performed. With precise delineation of anatomical structures, it is possible to render myocardial tissue characterisation and reproduce measurements of blood flow and volume (Peterzan et al., 2016). In doing so, regions of abnormal changes are highlighted and become easily distinguishable as symptomatic of heart failure (Fig 1). This is pivotal in underpinning characteristic tissue changes that are recognised with the onset of heart failure without pursuing invasive investigation. Additionally, the contrast mediums used in cardiac MRI exams, primarily gadolinium, are less likely to be contraindicated in allergic reactions than iodine-based radioactive contrast materials utilised in conventional X-ray and cardiac CT scans (Kanagala et al., 2018). While disadvantages persist in determining the suitability of cardiac MRIs for claustrophobic patients and for patients with metallic implants (neurostimulators and pacemakers), the advantages by far outweigh the results that are attained in proceeding with cardiac MRI scans. Perhaps more significantly and on a more global scale, accessibility to MRI scanners resides as an issue for individuals from remote areas and lower GDI nations (Peterzan et al., 2016). In such cases, resorting to less costly imaging modalities such as cardiac CT scans or echocardiography is apprehensible. However, while these factors do prevail, they do not withdraw from the revolutionary role of cardiac MRIs in heart failure diagnosis. These limitations only ground areas of development in forming universally accessible MRI type imaging techniques.

Figure 1. (A): patchy mid-wall late gadolinium enhancement. Arrows elucidate septal mid-wall and inferolateral wall fibrosis (B): autopsy sample from patient depicting the same pattern of fibrosis. This is indicative of the crucial role played by cardiac MRIs in capturing signs of early heart failure progression without the need for invasive investigation. (Taken from Assomull, 2007)

As an additive imaging modality, MRIs are able to be used in conjunction with x-rays, cardiac CT scans and echocardiographs to develop a holistic understanding of heart failure classification and strategies for therapy. Generally, chest x-rays are used to analyse the presence of an enlarged cardiac silhouette, pleural effusion and Kerley B lines to inspect heart failure likeliness (Peterzan et al., 2016; Stokes et al., 2016). In particular, pulmonary oedema is attributed to congestive heart failure. Following pressure increases in blood vessels, fluid is pushed against the alveoli in the lungs. These reflect chronic elevation of left atrial pressure and the thickening of the intralobular septa as a consequence of oedema (Fig 2) (Chalian et al., 2016). Therefore, x-rays allow for initial examination and prognosis of referred patients. However, it is the role of MRIs to correlate these issues recognised in X-rays to functional deficits of the heart in providing a diagnosis (Kanagala et al., 2018). Cardiac MRIs will provide accurate images of cardiac structures in evaluating myocardial disease. Most significantly, cardiac MRIs will detect focal and diffuse myocardial fibrosis and will evidence signs of cardiac amyloidosis, sarcoidosis, hemochromatosis and myocarditis in patients to diagnose heart failure (Karamitsos et al., 2009) (Fig 2). Hence, cardiac MRIs underpin the definitive diagnosis of patients and work superiorly to X-rays in detecting and determining the functional causes of initially abnormal X-ray observations.

Figure 2. Top Left: Bilateral pleural effusion indicated by arrows. Top Right: horizontal lines extending to periphery denote thickened oedematous interlobular septa following heart failure. Bottom left: short axis cardiac MRI in patient shows mid-myocardial enhancement in mid lateral and inferior segments indicated by arrows. Bottom Right: Fused PET/MR image after glucose diet elucidates patchy areas of intense uptake in lateral and inferior wall. Images highlight sequential method used in localising heart failure diagnosis and classification in patients (Taken from Fishman, 2017; Chalian, 2016).

Similarly, cardiac CT (FDG-PET/CT) scans are used in localising the presence of abnormal activity in the heart. FDG-PET/CT scans evidence abnormalities through high uptake and unusual FDG activity. When using PET with low dose CT scans, it is generally too difficult to localise lesions or to quantify thickened muscular walls in the heart. Therefore, MRIs are used to provide additional information in localising and characterising masses and abnormalities in patient scans (Adigopula & Grapsa, 2018). This is attributed to MRIs providing a 3-5-fold higher difference in image intensity between viable and infarcted myocardium.  For example, if a muscular mass is shown in an FDG-PET/CT scan, MRIs will be used as a complementary imaging modality for precise anatomical localisation. The cardiac MRI component also allows for functional information to be gauged on valve and papillary muscle function which can further be analysed by accurate quantification of ventricular and valvular function and activity (Chalian et al., 2016). Therefore, it is the pivotal role of cardiac MRI images in providing valuable anatomical and functional information that solidifies the ability for definitive diagnosis.


Figure 3. Top Left (a): Axial FDG-PET/CT image evidencing high uptake adjacent to SVC. Bottom Left (b): Four-chamber MR image show lipomatous hypertrophy of interatrial septum. Top Right: Myocardial infarction depicted by short-axis delayed enhancement MRI showing large transmural scar of anterior wall (yellow arrow) and partial thickness scarring of anterior wall (red arrow). Viability of this segment is borderline. Bottom Right: Fused PET/MR image shows no anterior or inferolateral uptake and elucidates viability. Therefore MR images are used collaboratively to determine functional changes that are attributed to CT scans depicting increased uptake. (Taken from Chalian, 2016)

There currently also resides an emerging potential where hybrid PET/MRI scans are employed for cardiovascular disease investigations. Fused PET/MR images can establish further precision by investigating viability assessments of abnormal segments via dye uptake. Practical applications use the high spatial resolution of cardiac MRIs to localise uptake of PET isotopes that are directed towards specific pathophysiological abnormalities (Chalian et al., 2016). Therefore, in combining the anatomical detail of MRIs with the sensitive metabolic information of PET, imaging is able to capture defects of sympathetic innervation in heart failure. This further solidifies a revolutionary role played by MRIs in heart failure diagnosis.

Echocardiography and cardiac MRIs also work collaboratively to elucidate the onset of functional and anatomical delineations in heart failure. Particularly, comparisons are investigated between the two imaging modalities when presenting left ventricular hypertrophy (LVH). Compared to echocardiography, cardiac MRIs offer a substantially improved endocardial visualisation and potential for assessing and evaluating scar tissue (Stokes et al., 2017; Coldea & Lupu, 2012; Valente et al., 2014). Moreover, cardiac MRIs are recognised to elicit high quality assessments of cardiac chamber measurements as a result of increased spatial and contrast resolutions. These further allow for delineation of endocardial and epicardial borders. While, echocardiographs are more cost effective and may be utilised as an initial imaging technique, cardiac MRIs are the gold standard method to determine both quantitative and qualitative evaluation of LVH (Valente et al., 2014). Echocardiographs encounter issues with tracing endocardial contours as a result of limiting contrast resolution. This grounds the revolutionary role of cardiac MRIs in proving high resolution images which allow for distinct tracing by depicting the presence of muscular borders from endocardial features such as trabeculations or papillary muscles. These traces are also now automated with cardiac MRI software.

Figure 4. Paired echocardiography and cardiac MRI from 4 patients presenting with maximal wall thickness identified precisely by only the cardiac MRI imaging modality. Regions of thickening are indicated by arrows (Taken from Valente et al., 2014)

In light of the additive role of cardiac MRIs, it is also pertinent to discuss the sole role of cardiac MRIs in the diagnosis of heart failure. The revolutionary role of cardiac MRIs can holistically be attributed to the broad-spectrum utility provided by MRIs in imaging various cardiac health problems (Fig 5). This elucidates the vital role of cardiac MRIs in the anatomical and functional characterisation of heart failure without the need to resort to secondary imaging modalities (Peterzan et al., 2016).

Figure 5. The broad-spectrum capabilities of cardiac MRI imaging techniques in distinct clinical settings. These underpin the revolutionary role of cardiac MRIs in heart failure assessment and subsequent tailorable diagnostic ability for HF characterisation (Taken from Chalian, 2016)

Contrast studies with gadolinium in cardiac MRIs prove invaluable when differentiating between ischemic and non-ischemic cardiomyopathy (Thompson & Maredia, 2017). The onset of late gadolinium enhancement (LGE) is fundamental in differentiating between the ischemic nature of cardiomyopathy (Francone, 2014; Boonyasiranant & Flamm, 2010). For example, patients presenting with dilated non-ischemic cardiomyopathy generally evidence a mid-wall distribution of LGE (Fig 6). LGE is a risk for heart failure. As a result, cardiac MRIs are able to elucidate the characterisation of heart failure by utilising non-ionising contrast agents.

Figure 6. Short axis cardiac MRI image in patient with dilated cardiomyopathy presenting mid-wall LGE distribution (Taken from Peterzan et al., 2016).

Moreover, the sole role of cardiac MRIs can also be examined in cases of heart failure with suspected iron overload. This is particularly pronounced in patients with thalassaemia, using T2 cardiac MRI for definitive diagnosis. In patients with heart failure and possible iron overload, cardiac MRI with T2 provides definitive diagnosis (Anand & Janardhanan, 2016; Peterzan et al., 2016). Heart failure will generally develop following prolonged periods of iron overload resulting in stiffened and weakened heart muscles.  Thus, if patients were diagnosed with heart failure, the aetiology of the disease would be attributed to the iron overload cardiomyopathy marking the use of cardiac MRIs as invaluable to heart failure assessment and diagnosis (Fig 7).

Figure 7. T2 cardiac MRIs in two patients presenting with thalassaemia. Left: iron loading of heart, spared liver. Right: iron loading of liver, heart spared (Taken from Peterzan et al., 2016)

Cardiac MRIs can also provide quantitative data during imaging. For example, the most common form of quantification is carried out in utilising highly reproducible measurements of ventricular volume, muscle thickness, myocardial mass and the flow of blood across heart valves. Ejection fraction is also a critical measurement used in analysing a weakened left ventricle (Agha et al., 2018). If a patient presents with a reduced ejection fraction (generally 40% or less), it is classified as a heart failure. Following imaging procedures and computerised quantifications, abnormalities are evidenced and able to be analysed on various planes with mathematical inputs. Measurements can also encompass ventricular size and function to establish heart failure characterisation and possible aetiology (Boonyasiranant & Flamm, 2010). Myocardial viability is therefore underpinned through quantitative cardiac MRI techniques.

T1-mapping techniques extend beyond standardised MRI techniques and allow for understanding of the pathophysiological processes culminating in heart failure development in a wide range of diseases. In determining diffuse myocardial fibrosis (DMF) and extracellular volume calculation, T1 mapping techniques allow for characterisation processes and diagnosis (Adam et al., 2017; Radenkovic et al., 2017). T1 mapping can also be pivotal in monitoring DMF measures in response to therapy. This develops diagnostic confidence in supplement to standard MRIs.

Holistically, these quantifiable measures suggest an inherent revolutionary role embedded in cardiac MRIs during heart failure diagnosis.

Conclusively, cardiac MRIs have profoundly established a revolutionary take on human heart failure assessment and diagnosis. It is the additive, sole and quantifiable capacities of cardiac MRIs that underpin the pivotal role played by cardiac MRIs in heat failure diagnosis, characterisation and aetiology determination. Through discussion of these factors it is unquestionable that MRIs are a superior imaging modality in the qualitative and quantitative assessment of heart failure diagnosis.

References

  • Adam, RD., Shambrook, J., Flett, AS 2017, ‘The prognostic role of tissue characterisation using cardiovascular magnetic resonance in heart failure’,

    Cardiac Failure Review,

    vol. 3, no. 2, pp. 86-96
  • Adigopula, S & Grapsa, J 2018, ‘Advances in imaging and heart failure: Where are we heading?’,

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Drug Overdose in America: Who is to Blame

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Drug Overdose in America – Whose Fault Is It?

Drug overdose in America is a collective fault that we all must share. In this paper, I will be taking a different approach by looking at the fundamental problems of substance use disorders (SUDs). As individuals, nature has created us in a way that makes us reliant on each other. our environment. As technological advancement increased, we as individuals unabatedly loose the constant interaction and communal relationship that has helped humans since time immemorial. We all are now busy with our gadgets and have taken human interaction to the barest minimal of all times. In a situation where we have little or no communication and association as required, certain lapses will be evident in the society. Substance use disorders as will be discussed here, includes people with alcohol abuse and drug abuse or dependence. About 9.4% (22.5million) people in the U.S are within this group

9

.  Between 199 and 2004, there was a 68% increase in drug overdose mortality

10

. For every individual undergoing substance abuse, we expect to see a link with socio-cultural matrix from which it stems. This behavior is an interplay between drugs themselves and environmental, genetic, behavioral, psychosocial and cultural determinants

1

. The basic truth is that, many young individuals presenting with these problems, are struggling with other issues that transcend social needs, crime, health or education. Ranging from lack of trust in people, to inability to judge or weigh alternative courses of action, to inability to hold normal relationships. It has been established that, children born to mothers with some form of SUD have higher levels of psychological disturbance

11

and are found with higher behavioral problems

12

and a heterogenous group of learning problems when compared to children born to non-drug abusing mothers. A lot of stimuli and experiences can impact development of the brain all through a lot of sensitive periods that are yet to be discovered. Example is as seen in the impairment of brain especially in areas responsible for learning, memory, anxiety and impulse control as a result of persistent neglect and ill treatment during early childhood. Children that experienced ill treatment and neglect in their early years have been seen to have higher likelihood of substance use

4

. A host of young people partaking in substance abuse have experienced generational adversity and are brought up in areas with feeling of loss of hopes and sense of hopelessness hanging in the air.

Studies have shown that throughout adulthood, new neurons are born

3

and these cell births can be impacted by lots of environmental factors and stimuli. Encounters ranging from physical to psychosocial stress can subdue the formation of these cells across a variety of mammalian species

5

. Evidence have shown treatment with antidepressants increasing formation of these cells through its boost of brain growth factors

6

. With all this information, one will wonder what the way forward is? Well, it is not far-fetched. A more constructive approach will have to be implemented. The readiness to lift each other up and not tear down. I call this the “community factor”. We need to go back to living as a community that look out for each other. We need to encourage a proper family system. We can start by collectively looking out for mothers in this blanket, helping them get out of it to reduce the likelihood of them producing children that will be at risk. This we can do, by  using appreciation to encourage a new perception of ordinary life. Instead of the use of evaluating stance that looks at deficiency, appreciation has to do with consenting to experience base on trust, conviction and belief. According to Cooperrider and srivastva, appreciation calls our attention to enlivening components of our environment, generating a mixture of passion and curiosity and gives inspiration to the photographic mind. In this instance, the eventual generative power that generates new values and images is the that with value, Appreciation

7

. Overtime, there have been a numerous report of controlled randomized trials that implicates Family/systemic therapies with best outcomes for the young generation involved in drug and alcohol abuse

8

. No matter the intensity of multi-dimensional family therapy observed, we might not still have enduring changes until we fix problems of poverty and marginalization. We need to all identify these group of people and intervene collectively as a society to help clear up this mess from the world. Until we see it as a collective duty, and rise to tackle it constructively, we might never feel the impact as we should.

 


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