HSM 410 Healthcare Policy Week 3 DQs and Assignment Devry
Question HSM 410 Healthcare Policy Devry Week 3 Week 3 DQ 1 What are some examples of painless cost control? Are these painless for everyone? Week 3 DQ 2 Describe and provide examples of price and quality controls. Week 3 Assignment: HSM 410 Week 3 Assignment; Healthcare Interview Paper (800+ Words)
Spinal muscular atrophy (SMA) is an autosomal recessive disorder that progressively disables motor neuron units in the spinal cord (Crawford & Pardo 1996). Motor neurons are specialised nerve cells that transmit electrical impulses from the spinal cord to the muscles that control movement in the limbs (e.g. for sitting, standing and walking) and in the body trunk (e.g. for swallowing and breathing). The dysfunction of these motor neurons results in progressive muscular weakness and atrophy, loss of movement capability and eventually, in severe forms of the disease, to respiratory failure.
The disorder was originally identified by Werdnig in 1891 and for the next hundred years treatment was limited to orthopedic aids to extend mobility and to nutritional and respiratory support to prolong life (Sumner & Crawford 2018). However, without mechanical ventilation, survival rarely goes beyond two years of age. SMA occurs in 1 in 6,000–10,000 live births and is the most common inherited cause of infant mortality (Van de Ploeg 2017).
The molecular mechanism that triggers SMA was identified by Lefebre et al. (1995) and that insight has opened the way to gene-based therapies that can moderate the progress of the disease. Recent developments have focused on gene-editing coupled with the generation of new motor neurons (motoneurogenesis) as a treatment that could even reverse the effects of SMA. This report examines the potential of gene-based therapies in the treatment of SMA and considers the specific question:
“should gene-editing be used with motoneurogenesis in the treatment and/or prevention of SMA?”
SMA categories are based on age at onset and severity of symptoms (Zerres et al. 1997):
All cells in the body require the survival motor neuron protein (SMN); complete elimination of the protein leads to cellular and progressively organism death. It is decreased levels of SMN within spinal cord neurons that triggers the neuromuscular pathology of SMA (Porensky & Burghes 2013). In infants with SMA1, irreversible loss of motor neurons begins during the first 3 months of life, and 95% of motor neurons are lost before age 6 months.
SMN is produced primarily by the SMN1 gene, but this gene is deleted or non-functional in about 96% of patients with SMA (Beroud 2003). Humans have a variable number of copies of a nearly identical gene, survival motor neuron 2 (SMN2), that can also produce SMN (see Fig1).
Fig 1: schematic of SMN gene (Kolb & Kissel 2015, Fig 4, p. 837).
However, a C to T substitution in an exonic splicing enhancer results in the exclusion of exon 7 during transcription of SMN2 means that most of the resulting protein is truncated and unstable; only about 15% of typical SMN1 levels of full-length SMN are produced by SMN2 and these are not sufficient for normal cell maintenance (Porensky & Burghes 2013). Higher number of copies of SMN2 per genome has been shown to correlate with decreased level of severity of the disease. Type I SMA is characterized by only two copies of SMN2; Type II by three or four copies; Type III & IV by five or more copies (Sumner & Crawford 2018).
The identification of the underlying genetic cause of SMA has prompted the investigation of gene-based therapies to induce increased SMN protein levels.
Gene-based technologies allow targeted manipulation of the human genome for therapeutic purposes. Modifications can replace defective DNA by: 1) the addition of beneficial exogenous genes to specific sites in the genome; 2) the removal of damaging genes; and 3) the specific editing of DNA strands to correct mutations within the gene structure (Maeder & Gersbach 2016).
Fig 2: Strategies for therapeutic genome editing (Maeder & Gerbach 2016, p. 435, Fig 3).
The application of gene therapy can be
in vivo
or
ex vivo
(see Fig 2). In an
in vivo
application, a carrier vector delivers either functional genetic material or a modification-inducing agent (e.g. a nuclease protein) that is targeted to a specific gene. In an
ex vivo
application
,
cells are modified and propagated
in vitro
and then transplanted into the patient.
Two established gene-based therapies for the treatment of SMA have used the
in vivo
mechanisms described by Chipman et al. (2012) to produce: 1) SMN2 enhancement; and 2) SMN1 replacement.
SMN2 enhancement by ASO
Antisense oligonucleotides (ASOs) can manipulate
in vivo
the pre-messenger RNA sequences that promote or inhibit exon splicing during RNA processing (Sumner & Crawford 2018). The ASO Nusinersen has been shown to enhance the effectiveness of existing SMN2 genes by promoting the inclusion of exon 7 into SMN2 transcripts during splicing of SMN2premRNA, which leads to increased encoding of normal full-length SMN protein. ASOs disperse widely when injected into the cerebrospinal fluid, without requiring a carrier; but they are not persistent and cannot cross the blood-brain barrier, so they must be delivered to the central nervous system by intermittent intrathecal injection.
Finkel et al. (2017) assessed the effectiveness of Nusinersen in a trial involving infants 80 ASO-treated infants (and 42 untreated infants), over a period of two years. At the completion of the trial, only 39% of ASO-treated infants failed to survive or required permanent assisted ventilation compared with 68% of the untreated infants; 51% showed markedly improved motor ability.
Nusinersen was approved for the treatment of SMA in USA in 2016. It is now subsidised in Australia through the Pharmaceutical Benefits Scheme.
SMN1 replacement by
scAAV9-SMN
The second therapy uses Avexis-101 (scAAV9-SMN), an adeno-associated virus (AAV) carrying exogenous SMN1 cDNA, to deliver a complete working copy of the SMN1 gene to the central nervous system (Mendell 2017). This new copy of SMN1 sits inside motor neuron cells, but does not incorporate into the child’s DNA; it’s essentially a supplemental gene that induces SMN expression
in
vivo
within the cells and peripheral tissues. AAV vectors are persistent and can cross the blood-brain barrier; they can be delivered to the central nervous system in a one-time postnatal intravenous injection.
In a study of 12 SMA infants treated with Avexis-101, Mendell (2017) found that all survived beyond the age of 20 months without requiring permanent assisted ventilation; all but 1 achieved levels of motor-functionality in feeding, sitting and talking, beyond those typical for SMA infants.
Although the patients in these trials were still producing SMN three years after treatment, it is not yet established that the single dose of this gene therapy will last throughout life. However, Avexis-101 is expected to be approved for the treatment of SMA in USA in 2019.
Patient screening
Both ASO and scAAV9-SMN therapies have been shown to deliver significant improvements in motor function as well as improvements in survival (Sumner & Crawford 2018). However, the precipitous drop in motor neurons in the early course of SMA means that, by the time that clinical diagnosis is made, a significant portion of motor neurons are most likely are already lost. A diagnosis of SMA in pre-symptomatic patients through screening would allow treatment of the disease before the onset of motor neuron loss or development of clinical symptoms (Chien 2017). Earlier treatment has been shown to deliver better outcomes – more patients respond and the response is larger (Sumner & Crawford 2018).
Non-invasive prenatal diagnosis of SMA has been shown to be feasible through the genetic analysis of fetal cells circulating in maternal blood (Beroud 2003) and more recently, a protocol for newborn genetic screening has been developed to predict SMA severity (Sumner & Crawford 2018). In the United States, the American Advisory Committee on Heritable Disorders in Newborns and Children has recently recommended nationwide newborn screening for SMA (Sumner & Crawford 2018). In Australia, newborn babies are now being routinely screened by testing drops of blood taken from the baby’s heel (Guthrie test).
Recent studies have investigated the potential of an
ex vivo
process that combines
in vitro
gene-editing to ‘correct’ pluripotent stem cells with motoneurogenesis to supply fully-functional motor neurons to the SMA patient.
Chipman et al. (2012) describe three techniques to generate motor neuron (MN) cells
ex vivo
for transplantation to the patient (Fig 3):
Fig 3: Techniques for the derivation of motor neurons (Chipman et al. 2012, p322, Fig 1).
A number of studies (e.g. Ebert 2009; Hester et al. 2011) have demonstrated the potential of
ex vivo
gene-editing to ‘correct’ pluripotent stem cells and use them as the source of fully-functioning motor neuron cells.
Gene-editing utilises the body’s endogenous cellular repair machinery to incorporate changes into the DNA strand sequence (Maeder & Gersbach 2016). A double-strand break (DSB) in the DNA is repaired either by direct religation of the cut ends (nonhomologous end-joining, NHEJ) or by mapping to the template provided by the parallel chromosome (homology-directed repair, HDR). Breaking the DNA strand at specific target points and introducing an exogenous template stimulates HDR repair mode; in that way, any sequence differences in the provided template are incorporated into the repaired site.
A number of platforms exist to induce DSBs at specific target sites in DNA while avoiding or minimizing collateral damage elsewhere in the genome (Maeder & Gersbach 2016). Three of these (zinc finger nucleases, transcription activator-like effector-nucleases, and meganucleases) require specific proteins for each target DNA site. A more recently developed platform is Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR associated protein 9 (CRISPR/Cas9) nucleases. CRISPR technology emulates an adaptive immune system found in bacteria that interferes with an invading virus by cutting its DNA at a specific site; CRISPR-associated (Cas9) proteins specify the DNA site to be cut by the Cas9 “scissors”. The encoding of the target site in only a short region of gRNA that can be easily altered makes the CRISPR/Cas9 technology a flexible and re-usable tool in gene-editing.
Corti et al. (2012) applied gene-edited motoneurognesis to SMA subjects in a mouse model. iPS cells were generated from skin fibroblasts and genetically modified
in vitro
. Single-stranded oligonucleotides were used to direct the edit of a T to C at position +6 of exon 7 in the survival motor neuron 2 (SMN2) gene. The inclusion of exon 7 in transcription converted the SMN2 gene into an SMN1-like gene that produces normal amounts of full-length SMN. Corrected motor neurons derived from the edited iPS cells were then transplanted back into the subjects. Treated subjects showed reduced SMA symptoms and extended life span compared with the control group of untreated subjects. The genetic modification was shown to be permanent and heritable (Corti et al. 2012).
Although the therapeutic outcomes of their study were positive, Corti et al. (2012) reported an issue that would limit the application of their technique, i.e. the oligonucleotides vectors used can produce mutations that interfere with normal cell function and might lead to tumorigenesis. This issue was addressed by Zhou et al. (2018) in a human-based trial that used CRISPR technology but using Cpf1 nuclease (instead of Cas9) as the targeting mechanism. Cpf1 was shown to be a more accurate and more efficient genome editing system for seamless genetic conversion of SMN2 to an SMN1-like gene. SMN expression was restored in the edited iPS cells and their derived motor neurons, without cell aberrations, i.e. with no exogenous sequences, normal karyotype and absence of tumorigenesis.
The positive results achieved by Zhou et al. (2018) were for an adult patient with Type 3 SMA. Further trials involving early-onset SMA cases are still needed to gain regulatory approval of this approach. However, the results show that the combination of gene-editing with motoneurogenesis is a safe, feasible treatment of SMA that can be used to effectively reverse the pathogenic effects of SMN deficit and provide a permanent, heritable cure for the disease.
The combination of gene-editing with motoneurogenesis targets the underlying genetic mechanisms that cause the disease. It can prevent further motor neuron loss/damage and, most importantly, can also replace motor neurons already lost at the time of diagnosis.
The recently developed techniques for more accurate site-targeting using CRISPR/Cpf1 have mitigated these risks (Zhou et al. 2018).
Spinal muscular atrophy (SMA) is a neurodegenerative disorder affecting the motor neurons in the spinal cord, leading to reduced mobility and early death. The condition is caused by a deficit in the survival motor neuron protein (SMN) as a result of genetic inheritance of a missing or dysfunctional survival motor neuron (SMN1) gene. Current gene-based therapies for SMA are designed to increase SMN levels, either by introducing exogenous SMN1or by enhancing the effectiveness SMN2, a parallel gene can also produce SMN but only in limited amounts. Both approaches have been shown to be effective in improving mobility and extending life span in SMA patients, but neither is a cure as they do not re-generate motor neurons.
Gene-editing with motoneurogenesis does not rely on any existing motor neurons.
In vitro
gene-editing of induced pluripotent stem cells to amend SMN2 to an SMN1-like gene can provide new fully-functional motor neurons for transplant back into the patient. The process employs established techniques for cell harvesting and transplantation; the CRISPR/Cpf1 technology has been shown to be a safe and efficient tool to achieve accurate gene-editing. The corrected motor neurons have been shown to be effective as a treatment of SMA in mouse models and more recently in human trials.
Gene-editing with motoneurogenesis will provide feasible, low-risk treatment of SMA, with positive therapeutic outcomes for the individual patient; for society, the genetic mechanisms of this approach offer a heritable cure not only for SMA but possibly also for other similar disorders. This analysis concludes that gene-editing coupled with motoneurogenesis should be used in the treatment and/or prevention of SMA.
Genetic testing plus IVF can sidestep genetic disease and reduce the need for high-priced therapies
.
Step 1 The scenario:
You are a nurse at Samaritan General Hospital. You have been asked to create patient education handouts for a variety of integumentary disorders. After you gather the information to put in the handout, you will ask your peers for feedback on the information.
Step 2 Select an integumentary disorder that you would like to learn about and, if necessary, research the pathophysiology of the disorder.
Step 3 Your first task is to describe the pathophysiology of the disorder that you will include in the patient handout. This information should be followed by common signs and symptoms of the disorder. Be sure to cover the pathophysiology of the disorder in terms a patient (or his or her caregiver) would be able to understand. Be sure to cite all sources you use and provide a reference using proper APA formatting.
Welcome to Kindly Residential Care Rest Home
Introduction
The “Employee Handbook” here summarises the procedures, policies and strategic HR practices related to and with Kindly Residential Care Rest Home.
The Kindly Residential Care Rest Home is headed by the “Executive Director” who will lead the concerned staff and responsible for the development and implementation of the policies, procedures and practices that are mentioned and declared in this “Employee Handbook”. As a routine the strategic human resource management will be undertaken by the HR Managers who will be responsible for the all respective concerns of their staff teams and will make sure that this manual should be used as a reference while applying any of the strategic HR practices within the organisation to remain consistent with the goals of the organisation.
The “Senior HR Manager” is accountable to maintain the policies and procedures in a systematic way within the organisation and he will be the one to deal with queries and explanations with respect to the employee handbook and remain answerable for the same. This may include questioning about the wages, allowances, holidays, sick and maternity leave, benefit packages, health plans, retirement plans, kiwi saver and insurance.
In Kindly Residential Care Rest Home the HR Management is committed to recognise the strategies that involve the provision of healthcare while caring of the residents and as well as that which comes from employing staff premises and managing human resources and also the practices that are present on a daily basis throughout the organisation and to fallow health and safety legislation and safeguard procedure wherever applicable for the safety of the residents, staff and public by integrating governance and strategic human resource management
[1]
.
The New Zealand Healthcare System
For our employee it is important to understand that where we are in the NZ healthcare system and how the health system works in NZ as NZ is the country of diversity and there are lots of employee from different backgrounds cultures and countries. The following is the overview of the NZ healthcare system in the form of a flow chart.
From the above flow chart we can see that the position of our rest home lies in the section of Private and NGO providers which is under the supervision of DHB (Compliance with the NZ Public health and Disability Act 2000
[2]
), Ministry of Health and there is additional support provided by ACC, DHB provider arm (Hospitals/GP), Private health insurance and PHARMAC (A government of NZ undertaking pharmaceuticals management company
[3]
).
The Statement of Philosophy
The statement of Kindly Residential Care Rest Home is to provide a better work atmosphere which will facilitate professional growth of the entire employee and maintain their personnel lives as well and vice versa. Not only that but it’s a duty of the HR managers and the Supervisors to foster each employee of the Rest Home on personal basis as the Kindly Care Rest Home considers its employee as an asset to the organisation. On the other hand the Kindly care Residential Rest Home will expect the fallowing responsibility of all staff.
The Policy Statement
This HR management strategy, policy and procedures are intended to provide out the Kindly Care Residential Rest Home with key aims and objectives to develop all culture and processes within the organisation to ensure the perfect and effective system to manage the facility through our team members. The policy also outlines the key objectives and aim with respect to the Rest Home in our “Employment Handbook”. The policy executes the strategy to ensure the infrastructures required to address the strategy are in their respective place. The document will be equipped with guidance to provide advice on implementing systems that are effective in managing the facility and its employee.
Who We Are
We are one of the leading service providers with innovative approach in the field of quality eldercare with 88 bedded five winged multispecialty rest home with spacious rooms, separate lounges, welcoming and well-appointed outdoor areas and featured facility which includes diverse activity programmes, extra services like physiotherapy, podiatry, aromatherapy, reflexology, spa and hair saloon offering high/low care and respite care situated in the southern suburbs of kindly park, convenient to kindly shopping centre and the new kindly park interchange.
None the less but we are the “Home away from Home” with an excellent eldercare service provision with a qualified and skilful staff of 103 which is scheduled 24hrly to meet all the desire of our residents day and night to ensure their health and safety and to make them as comfortable as if they are at their own home.
Our Vision
We want eldercare services to take account of the diversity of local populations without compromising “quality of service”. Health services should be “accessible to all” community clients and applicants for healthcare services regardless of a person’s characteristic. We see ourselves as the “innovators” to develop and raise our employee and the facility to cite an example in the field of “cost effective” eldercare. An eldercare for all under one Home!
Our Mission
The ultimate mission of the Kindly Residential Care Home is to be the one in the provision the “exceptional quality care” to our community residents and elderly through the services of highly “skilled and qualified staff” and to “create develop innovate” the best employees ever prepared and managed by the HR in the field of healthcare. The management’s strategy policy procedures and guidance document is to strengthen the rest home employee and the HR personnel to deal and manage the day to day operational functions to meet its management objectives in strict compliance with the standards, rules and regulations
[5]
.
Our Core Values
All the members and employee of Kindly Residential Care Rest Home will remain committed and striven by our core values and quality principles in their everyday work to achieve our mission.
The Scope
The scope of policy is wide and applies to all Kindly Residential Care Rest Home employees, stakeholders and locum business units and partners in collaboration.
Our Organisational Structure
The following flow chart shows the organisational structure of our Kindly Residential Care Rest Home and Governance in accordance to the HR department and staff of the facility.
[1]
National Care Planning council. (1993). The Caregiver’s Handbook. Retrieved from:
http://www.longtermcarelink.net/eldercare/the_caregivers_handbook.htm#introduction
[2]
Statistics New Zealand. (2008). Measuring Government Sector Productivity in New Zealand. Retrieved from:
http://www.stats.govt.nz/browse_for_stats/economic_indicators/productivity/measuring-govt-productivity/6-health-care.aspx
[3]
The Healthcare in New Zealand. (2010, Jun). The Breakdown. Retrieved from:
http://beninauckland.blogspot.co.nz/
[4]
HR Council for the Voluntary & Non-Profit Sector. HR Toolkit. Employee Handbook. Retrieved from:
https://www.google.co.nz/url?sa=t&rct=j&q=&eloading=”lazy” src=s&source=web&cd=13&cad=rja&uact=8&ved=0CFgQFjAM&url=http://hrcouncil.ca/hr-toolkit/documents/CAHRC_HR_Manual.doc&ei=34Y3VPbCMoL88QXrzoDoCQ&usg=AFQjCNFDQoppMs5I8efCdwvq04SXqoaKvw
[5]
Convenient Home Care Services Inc. Employee Handbook. Retrieved from:
http://www.convenienthomecare.com/documents/Employee_Handbook.pdf
[6]
Employee Handbook. John Hopkins Health System Corporation. Retrieved from:
http://www.hopkinsmedicine.org/human_resources/_docs/employee_handbook_non-union_non-represented.pdf
The Cost of Capital And The Basics of Capital Budgeting: Evaluating Cash FlowsInstruction: Please submit your assignment as an attachmentto my Blackboard email by midnight on the due datePLEASE USE EXCEL TO SOLVE ALL PROBLEMSProblem 1You are employed by ABC Inc. Your boss has asked you to estimate the weighted average cost of capitalfor the company. Following are balance sheets and some information about CGT.AssetsCurrent assets $30,000,000Net plant, property, and equipment $100,000,000Total Assets $130,000,000Liabilities and EquityAccounts payable $10,000,000Accruals $10,000,000Current liabilities $20,000,000Long term debt (40,000 bonds, $1,000 face value) $40,000,000Total liabilities $60,000,000Preferred Stock (100,000 shares, $100 face value) $10,000,000Common Stock (10,000,000 shares) $30,000,000Retained Earnings $30,000,000Total shareholders equity $70,000,000Total liabilities and shareholders equity $130,000,000You check The Wall Street Journal and see that ABC stock is currently selling for $10.00 per share and thatABC bonds are selling for $1100.0 per bond. These bonds have a 7 percent coupon rate, with semi-annualpayments. The bonds mature in twelve years. The preferred stock has an unlimited life and pays an 5percent annual coupon. The preferred stock sells for $95. The beta for your company is approximatelyequal to 2. The yield on a 20-year Treasury bond is 4.0 percent. The expected return on the stock market is8.0 percent. ABC is in the 40 percent tax bracket.2. Davis Corporation is faced with two independent investment opportunities. Thecorporation has an investment policy which requires acceptable projects torecover all costs within 3 years. The cost of capital is 10 percent. The cash flowsfor the two projects are:Project A Project BYear Cash Flow Cash Flow0 -$120,000 -$90,0001 42,000 30,0002 43,000 30,0003 44,000 30,0004 45,000 30,0005 46,000 30,000Which investment project(s) does the company invest in using the:1)Payback period rule2)Discounted payback period rule3)NPV4)IRR3. XYZ Corporation is faced with two mutually exclusive investment opportunities.The cost of capital is 12 percent. The cash flows for the two projects are:Project A Project BYear Cash Flow Cash Flow0 -$140,000 -$100,0001 60,000 30,0002 60,000 30,0003 60,000 30,0004 30,0005 30,0006 30,000Which investment project should the company invest in using the:1.Equivalent annual annuity approach2.The replacement approachPlease name this file as:Assignment 6 first_name last_name.docIf you have any questions, feel free to contact me.
Children and youth who sustain a severe traumatic brain injury (TBI) and/or a spinal cord injury (SCI) often experience sequealae that can affect their ability to communicate effectively. In early phases of recovery, many children with TBI and SCI are unable to use their speech or gestures for a variety of neurological and medical reasons related to their injuries. As a result, they can benefit from augmentative and alternative communication (AAC) interventions that specifically address their ability to communicate basic needs and feelings to medical personnel and family members and ask and respond to questions. AAC approaches may include having access to a nurse’s call signal; strategies to establish a consistent “yes” “no” response; techniques that help a child “eye point” to simple messages; low-tech boards and books that encourage interaction with family members and staff; communication boards with pictures or words; and speech generating devices (SGDs) with preprogrammed messages, such as “I hurt” “Come here,” “Help me please!” “When’s mom coming?”
As children with TBI and SCI recover from their injuries, many no longer will need AAC. However, some children face residual motor, speech, language and cognitive impairments that affect their ability to communicate face-to-face, to write and to use mainstream communication technologies (e.g., computers, email, phones, etc.). A few may require AAC and other assistive technologies (AT) throughout their lives to participate actively in the rehabilitation process and ultimately, in their families and communities as adults. Without the ability to communicate effectively, children with TBI and SCI face insurmountable barriers to education, as well as difficulties establishing and maintaining relationships and taking on preferred social roles.
All AAC interventions aim to support a child’s current communication needs while planning for the future [2]. However, the course of AAC treatment for children who sustain TBIs and for those with SCIs is different because the nature of their injuries is different. In addition, the focus of AAC interventions will differ for very young children who are just developing speech and language skills (e.g., 18 month-old with shaken baby syndrome) and for those who were literate and already had some knowledge of the world prior to their injuries (e.g., 16 year-old injured in a motor vehicle accident). For young children, the AAC team will focus on developing language, literacy, academic, emotional, and social skills, as well as ensuring that they have a way to communicate with family members, rehabilitation staff and others in their lives. For older children, AAC interventions often build on residual skills and abilities to help remediate speech, language and communication impairments while providing compensatory strategies that support face-to-face interactions and ultimately communication across distances (phone, email). In short, AAC intervention goals often seek both to remediate and compensate for injuries while promoting a child’s access to social networks and active participation in family, education, community and leisure activities [4, 18, 25].
A variety of AAC tools, strategies and techniques are available that offer communication access, however, successful AAC interventions for children with TBI and SCI also require that medical staff, family members and ultimately community personnel know how to support their use. The needs of these children change over time so speech-language pathologists, nurses, occupational therapists, physical therapists, physiatrists, pediatricians, and rehabilitation engineers need to work collaboratively with the child’s family and community-based professionals to establish, maintain and update effective communication systems. Ultimately, these children need to return to their homes, schools and communities and, as adults to take on desired social roles. AAC can help them realize these goals.
AAC intervention for pediatric patients with TBI and severe communication challenges is an essential, complex, ongoing and dynamic process. AAC is essential to support the broad range of communication needs of children with TBI who are unable to communicate effectively. It is complex because of the residual cognitive deficits that often persist and because many children with TBI have co-existing speech, language, visual, and motor control deficits [11, 10]. AAC interventions are ongoing and dynamic [12] because children with TBI experience many changes over time and undergo multiple transitions. Light and colleagues [17] described the ongoing, three-year AAC intervention of an adolescent who progressed through several AAC systems and ultimately regained functional speech. DeRuyter and Donoghue [6] described an individual who used many simple AAC devices and a sophisticated AAC system over a seven-month period. Additional reports describe the recovery of natural speech up to 13 years post onset [15, 29].
Assessment tools can help identify and describe the cognitive, language and motor deficits of patients with TBI and can provide a framework for AAC interventions. The Pediatric Rancho Scale of Cognitive Functioning [26] is based on the Ranchos Los Amigos Scale of Cognitive Functioning [13]. Table 1 describes general levels of recovery, based on the Pediatric Rancho Lost Amigos Scale, and gives examples of AAC intervention strategies that rehabilitation teams can employ across the five levels, as described below.
Levels V and IV. Shaping responses into communication
Pediatric patients at Levels V and IV on the Pediatric Rancho Scale are often in the PICU, the ICU, acute hospital or acute rehabilitation environment. At Level V (no response to stimuli) or Level IV (generalized response to stimuli), AAC interventions focus on identifying modalities that children can use to provide consistent and reliable responses. For example, staff can use simple switches, latch-timers and single message devices to support early communication (see Table 1 for some examples). Because children’s early responses may be reflexive rather than intentional, the family and medical/rehabilitation team can also use AAC technologies to encourage more consistent responses. Families provide valuable input about the kinds of music, games and favorite toys a child finds motivating and the team can use these items to evoke physical responses from the child. For example, if a family identified the battery-operated toy Elmo® from Sesame Street®, the rehabilitation team might present Elmo singing a Sesame Street song and then observe to see if (and how) the child’s responds. If the child begins to turn her head when Elmo® sings, the team might attach a switch with a battery interrupter to the toy and ask the child to “hit” the button and “play the Elmo® song”. In doing so, the team can learn several things. For example, the team may note that a child is able to follow commands, indicating cognitive recovery. The team may also begin to consider alternative access methods for a child with severe physical impairments, noting, for example, that head movement may become a reliable way to operate an AAC device or computer in the future.
Pediatric patients at Levels III (localized response to sensory stimuli) and II (responsive to environment) become more engaged in their rehabilitation programs as they recover some cognitive, language and physical abilities. Natural speech recovery is likely to occur during this phase and long-term deficits that affect communication become more apparent (e.g., dysarthria, apraxia, aphasia, attention, initiation, memory, vision, spasticity). Dongilli and colleagues [7] and Ladtkow and Culp [16] reported natural speech recovery in adults after TBI at these stages of recovery, and continued reliance on AAC strategies and technologies is typically due to persistent motor speech and/or severe cognitive-language deficits resulting from the injury [12].
AAC interventions at these levels typically focus on using a child’s most consistent and reliable response to (1) communicate messages, (2) encourage active participation in the rehabilitation process and (3) increase interactions with family and staff. AAC interventions always take into account the child’s developmental level and interests. Table 1 gives some examples of AAC technologies employed during Levels III and II. For example, Jessica was admitted to the hospital at 18-months with shaken baby syndrome. At Level II, she began responding to her parents by smiling and laughing, and she also began to manipulate toys with her non-paralyzed hand when staff placed a toy within her intact field of vision. However, she did not exhibit any speech or imitative vocal behaviors and her speech-language pathologist noted a severe verbal apraxia. Nursing staff and family members reported that Jessica seemed frustrated by her inability to express herself. Prior to her injury, she could name over 30 objects (toys, pets, favorite cartoon characters) and was beginning to put two word sentences together (Momma bye-bye, Daddy home).
AAC interventions included the introduction of a single-message speech generating device (SGD) that enabled the staff and family members to record a message that Jessica could then “speak” during her daily activities (e.g.,more, bye-bye, turn page). Because the device selected was colorful, large and easy to access, Jessica was able to “press the button” despite her upper extremity spasticity and significant visual field cut. Within a month, she was also able to use an SGD with an eight-location overlay that staff had programmed with words she used prior to her injury (e.g., mommy, daddy, more, bottle, book, bye-bye). Staff also designed additional overlays to encourage language development so she could construct two-word combinations (e.g., more crackers). Jessica began to express herself at a developmentally appropriate level when her communication partners gave her cues because she had residual memory deficits. For example, initially, she did not recall how to use her AAC system from session to session so staff needed to reintroduce it each time; but after several months, Jessica began to “search” for her SGD to communicate. Like many children with TBI at this level, she was able to learn procedures and strategies with repetition and support [30].
As pediatric patients transition from Level II (responsive to environment) to Level I (oriented to self and surroundings), they often move from an acute rehabilitation facility to an outpatient setting, their home or a care facility. Before discharge, therefore, AAC teams often conduct a formal AAC assessment and provide long-term recommendations for AAC strategies and technologies that will enable children to be integrated successfully back into community environments. Table 1 illustrates the types of AAC technologies and strategies employed at Levels II and I.
For children who continue to use AAC and AT when they return to their communities, the rehabilitation team will identify a long-term communication advocate. This person, often a family member, collaborates with rehabilitation staff to prepare the child’s educational staff, extended family and other caregivers to support communication across environments [9]. Having a link between the rehabilitation team and community professionals is essential because most teachers and community-based clinicians need support to manage the cognitive and physical deficits often associated with TBI. For example, McKenzie, a 12 year-old with a severe TBI secondary to a car accident, was quadriplegic with severe spasticity and no upper extremity control. She also had cortical blindness and significant communication and cognitive impairments. As she recovered, McKenzie used a variety of AAC systems (e.g., thumbs up/down for “yes” “no”, two single message SGDs to communicate choices, and a auditory scanning device that enabled her to access four messages so she could participate in structured activities). Prior to discharge, the rehabilitation team conducted a formal SGD evaluation and recommended a dynamic display SGD with synthesized and digitized speech output that McKenzie could access via a head switch mounted to the side of the headrest on her wheelchair. Using auditory scanning, she could create and retrieve messages. Because she had been literate prior to her injury and could still spell, the staff set up her device with an alphabet page as well as several pages with pre-programmed messages containing basic/urgent care needs, jokes and social comments. Her family and friends learned to use tactile and verbal prompts to help her participate in conversational exchanges. Even so, due to residual cognitive deficits, McKenzie had difficulty initiating conversations and remembering where pre-stored messages were in her device although when prompted, she would respond. She could also initiate questions and engage in conversations over multiple turns. Over time, she began to participate in meaningful, social interactions, often spelling out two-to-three word novel phrases using her SGD with the alphabet page.
McKenzie transitioned to a regional care facility that specialized in working with young people with TBI while her parents were preparing their home to handle her wheelchair, The acute rehabilitation team had identified McKenzie’s aunt as her AAC advocate because she participated actively in earlier phases of McKenzie’s recovery and knew how to charge, set-up and do basic trouble-shooting of her SGD, as well as could customize and program new messages into the system. The care facility staff met with McKenzie’s aunt weekly and learned how to support McKenzie’s use of the SGD. Specific training objectives also included maintenance and basic trouble-shooting, set up, switch-placement and programming new messages for use in specific and motivating activities. Staff also learned how to modify the placement of McKenzie’s switch when she became fatigued or her spasticity increased. Additionally, McKenzie’s school staff (special education coordinator, speech-language pathologist, occupational therapist, and one of her regular classroom teachers) visited McKenzie to help prepare for her return home. They wanted to learn how to support her in school, given her physical and cognitive limitations.
When working with pediatric patients with TBI, three AAC “themes” emerge.
Pediatric patients with SCI often have intact cognitive skills and severe physical disabilities that can interfere with their ability to speak during the acute hospital and rehabilitation phases of recovery. In addition, they often have significant medical complications and may be left with severe neurological impairments that make it difficult, if not impossible, for them to write, access a computer or participate in the gaming, online and remote social networking activities embraced by today’s youth (e.g., texting, email). A subgroup may also present with a concomitant TBI. For them, AAC treatment must reflect guidelines that take into account both SCI and TBI.
As with TBI, AAC intervention for children with SCI is developmentally based and directed to the individual’s special needs [27]. Initially, AAC interventions typically focus on ensuring face-to-face communication when speech is unavailable or very difficult; however, over the long term, enabling children to write and engage in educational, recreational and pre-vocational activities using computers and other mainstream technologies becomes the focus.
The ASIA standard neurological classification of SCI from the American Spinal Injury Association and International Medical Society of Paraplegia [1] is a tool that rehabilitation teams frequently use to assess patients with SCI because it identifies the level of injury and associated deficits at each level. It can help guide the rehabilitation team’s clinical decision-making process for AAC interventions. As shown in Table 2, children with high tetraplegia (C1-C4 SCI) have limited head control and are often ventilator dependent. They may require eye, head, and/or voice control of AAC devices and mainstream technologies to communicate. While switch scanning is an option for some, it requires higher-level cognitive abilities, endurance, and vigilance and may be inappropriate for very young children and those who are medically fragile [28, 19, 23, 14].
Children with low tetraplegia (C5-T1 SCI) demonstrate limited proximal and distal upper extremity control. If fitted with splints that support their arm and hand, some are able to use specially adapted mouse options (e.g., joystick mouse, switch-adapted mouse, trackball mouse), large button or light touch keyboards and switches to control technology. These children are also candidates for head tracking and voice control of AAC devices, options that can offset the fatigue and physical effort involved in using their upper extremities. A multi-modal access method to AAC technology and computers may include voice control to dictate text, hand control of the cursor with an adaptive mouse to perform other computer functions (e.g., open programs) and an adaptive keyboard to correct errors that are generated while dictating text and can be more efficient and less frustrating than using voice control alone. Table 2 provides examples of appropriate access options to AAC and mainstream technologies.
For children with high tetraplegia, being dependent on mechanical ventilation is frightening especially for those who are unable to tolerate a talking valve [21]. Also, children with lower levels of injury can experience reduced respiratory control and be unable to speak as they are being weaned from a ventilator[2]. For any reason, providing a way to communicate is essential to recovery and a sense of well-being. AAC strategies and technologies can enable these children to interact with direct care staff, participate in their rehabilitation process, and maintain relationships with family and friends.
Pediatric rehabilitation teams may use a range of AAC strategies and technologies to support face-to-face communication in children with SCI. Some examples include low tech communication boards used with eye gaze or eye pointing, partner-dependent scanning, an electro larynx with intra-oral adaptor and a laser light pointing to a target message or letter on a communication board [2, 3]. Introducing AAC and AT technologies early in the recovery process, particularly for children with high tetraplegia, begins to familiarize them with approaches they may need to rely on more extensively throughout their lives, even after their speech returns.
For example, Jared, a 17-year-old high school senior, sustained a SCI at the C2 level in a skiing accident. In addition to his injuries, he developed pneumonia and a severe coccyx wound that lengthened his hospital stay. He was unable to tolerate a one-way speaking valve due to the severity of his pneumonia and decreased oxygenation during valve trials. Although Jared had minimal head movement, he was able to control a head tracker to access his home laptop computer and could spell out messages he then spoke aloud using speech synthesis software. He used this AAC system to indicate his medical needs to caregivers and later reported that having the ability to communicate helped alleviate some of the anxiety he experienced due to his condition and extended hospitalization. When Jared could use a talking valve, his AAC program focused on computer access to meet written and social communication needs. Once his wound had healed and he returned home, Jared completed his GED and enrolled in online classes at the local community college using his AAC system.
At the time of their injury, some pediatric patients with SCI are pre-literate, othehrs are developing literacy skills, and others have highly developed literacy skills. Most children with tetraplegia require the use of assistive technologies to support written communication because their injuries preclude them from using a pencil and/or typing on a traditional computer keyboard. In fact, in a report describing the educational participation of children with spinal cord injury, 89% of the children with tetraplegia relied on AAC to support written communication needs [8].
For example, Max, a 6-year-old boy who suffered a C6 SCI after an All Terrain Vehicle accident, was reading age-appropriate sight words and developing his ability to write single words prior to his injury. Formal testing revealed that Max had no residual cognitive or language impairments; however, he faced significant barriers to his continued development of age-appropriate reading and writing skills, as well as his ability to learn and do math, social studies, science, play games, use a cell phone, etc. Max needed ways to access text and write, calculate, draw, play computer games (?) and so on. He learned to access a computer using a large button keyboard, joystick mouse, and adaptive hand-typers (cuffs with an attached stylus that fit on the ulnar side of the hand and allowed him to press keys on a keyboard). These technologies supported writing and computer access; and as a result, he was able to continue with his schoolwork and keep up with his classmates. After returning home during the summer and participating in an intense home tutoring program, he joined his classmates in the fall and performed at grade level in all his classes. Essential to Max’s future educational success and development, as well as his future employment, is his ability to write, calculate and perhaps even draw using a variety of assistive technologies that support communication.
Access to assistive and mainstream technologies not only facilitates participation in education, but also has implications for future employment as children transition into adulthood. Assistive and mainstream technologies that can help individuals with SCI achieve gainful employment and participate actively in their families and communities are now available at modest cost. In addition, these technologies provide access to life-long learning, recreational activities and social networking opportunities. Specifically, computers are described as “great equalizers” for individuals with SCI [20].
Social participation in the current technological age includes more than face-to-face communication. Social participation has expanded with the popularity of social networking sites (e.g., Facebook ™and MySpace™), video web-based communication (e.g., Skype™) and instant communication and messaging (e.g., Twitter™). Advances in the field of AAC have allowed individuals with the most severe injuries to engage in these social communication activities. For example, Crystal, a 10-year-old who sustained a C1 SCI due to a fall, had no head/neck control and her only consistent access method to computerized technology was through eye tracking. Using an ERICA eye gaze system from DynaVox Mayer-Johnson, Crystal was able to email and text her friends and family daily, communicate via her Facebook™ account, and engage in online gaming programs with her friends and siblings. This technology also allowed her to communicate with her school friends while she was still undergoing acute rehabilitation. Additionally, Crystal’s friends began to understand that while her impairments were severe, she was essentially the same person with the same interests, humor, goals, and expectations as before her injury. Maintaining social networks is an essential component to emotional adjustment for children with SCI [8].
When working with pediatric patients with SCI, three AAC “themes” emerge.
Communication is essential for the development of cognitive, language, social, and emotional skills. Children with TBI and SCI have physical and/or cognitive-language deficits that may interfere with typical ways of communicating. However, AAC strategies and technologies can support their varied and ongoing communication needs across environments and over time. A myriad of technology options are currently available that not only address face-to-face interactions, but also distant social networking, educational, leisure and employment needs.
AAC interventions in medical settings address the communication of basic medical needs and facilitate a child’s recovery and engagement in the rehabilitation process. For those who continue to need communication supports, AAC technologies increase the likelihood that children with TBI and SCI will make successful transitions to their homes, schools and communities and as adults, can take on desired social roles.
hsa 515 week 11 exam part 1
Question 1
0 out of 6 points
The delineation of clinical privileges is the process by which the medical staff
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Question 2
6 out of 6 points
When a patient is injured as a result of a doctor who’s practicing in a clinical area with which he is not familiar, the patient must show that the
Answer
Question 3
6 out of 6 points
The National Practitioner Data Bank (NPDB) was created by Congress
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Question 4
6 out of 6 points
The most common cause of malpractice suits against physicians
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Question 5
6 out of 6 points
A State Medical Board
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Question 6
6 out of 6 points
Mrs. Ard noticed that her husband was having difficulty breathing. He was reeling from side to side in bed. Believing that her husband was dying, she continued to call for help, estimating that she rang the call bell for 1.25 hours before anyone responded. A code was eventually called. Unfortunately, Mr. Ard did not survive the code. The court determined that
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Question 7
6 out of 6 points
A nurse hired by a patient or the patient’s family to perform nursing services
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Question 8
6 out of 6 points
Each state has its own nurse practice act that defines the practice of
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Question 9
6 out of 6 points
The Navy veteran in Vanhoy v. United States successfully underwent coronary bypass surgery at the Veterans Affairs Medical Center. However, he was injured as a result of being left unattended for several hours by nursing personnel in the intensive care unit. The veteran suffered anoxic brain injury following a complication with his endotracheal tube. A lawsuit was filed and the court determined that
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Question 10
6 out of 6 points
The scope of practice refers to the permissible boundaries of practice for health care professionals, as is often defined in
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Question 11
6 out of 6 points
A chiropractor is required to exercise the same degree of care, judgment, and skill exercised by other reasonable
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Question 12
6 out of 6 points
The objectives of emergency care are
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Question 13
0 out of 6 points
If a patient decides to leave an emergency department without notice because of a delay in being treated, the courts would generally hold
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Question 14
0 out of 6 points
Medication Misadventures can be decreased by
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Question 15
0 out of 6 points
Caregivers should be sure to
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Question 16
6 out of 6 points
The Privacy Act of 1974 was enacted to
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Question 17
0 out of 6 points
Ordinary business documents are
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Question 18
6 out of 6 points
When making changes to a patient’s record
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Question 19
0 out of 6 points
The length of time medical records must be retained
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Question 20
6 out of 6 points
The process of facilitating the flow of information within and among departments and caregivers.
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Question 21
6 out of 6 points
Primary responsibility for obtaining informed consent from the patient lies with the
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Question 22
6 out of 6 points
Informed consent is a legal doctrine that provides that a patient has the right to know the
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Question 23
6 out of 6 points
Informed consent is
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Question 24
6 out of 6 points
The ethical rationale underlying the doctrine of informed consent is
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Question 25
6 out of 6 points
The clinical assessment of decision-making capacity should include the patient’s ability to:
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Question 26
6 out of 6 points
Information reported to the data bank
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Question 27
6 out of 6 points
Incident reports contain statements made by employees and physicians regarding
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Question 28
6 out of 6 points
Most states have enacted laws that require the reporting of
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Question 29
0 out of 6 points
Data bank queries can be made by
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Question 30
6 out of 6 points
The purpose of a medical examiner’s investigation is to
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What are the two types of forms used for health services billing?
CMS 1501 and CMS 1450
UB 04
CMS 1100 and CMS 1450
UB-05 and UB-1450
Question 2
Describe how Medicaid payments to providers are limited by the federal government.
The payments to providers are not limited by the federal government but rather by state agencies that have predetermind estimates.
The law requires that Medicaid payments to qualified hospitals, nursing facilities, ICF/MRs, and clinics not exceed a reasonable estimate of the amount that Medicare would pay for equivalent services in the aggregate within state-owned or operated, non-state-owned or operated, and private facilities.
2. Delivery: a. Report: you should submit a feedback report (word format) includes the following:
Use the uploaded files to complete the project:
Introduction
Urinary tract infections, also called cystitis or infectious cystitis, is an acute infection that occurs within the upper, or the lower urinary tract. Women are at greater risk of developing urinary tract infections compared to the men. In women, the urinary tract infections are frequently caused by bacteria such as Escherichia coli, or Staph commonly found in bowel flora and may move through the urinary tract, causing infections in the bladder or the other components of urinary tract (Flores-Mireles et al., 2015). Osteoporosis is a chronic illness where the bones become weak and are more probable to break or fracture. Osteoporosis is characterized by the decreased bone mass with the disruption of the architecture of the bone that leads to augmented risks of the fragility fractures that are the major consequences of the illness. Women are at higher risks for osteoporosis after the menopause due to lower levels of the estrogen (Hiremath et al., 2018). This paper discusses urinary tract infections and osteoporosis in women.
The Issue, Prevalence, and Significance
Urinary tract infections (UTIs) are the most common, widespread infection in women since they have shorter urethras that permit bacteria fast access to the bladder. Urinary tract infections among women is associated with burning when urinating, pelvic pain, frequency of urination, and augmented urgency of urination (Flores-Mireles et al., 2015). The prevalence of the UTI is approximated to be about 150 million individuals each year across the world. Almost fifty percent of women reports having had a UTI during their lives. Urinary tract infections are the primary cause of morbidity and healthcare expenditures in women across the world. This type of infection is frequent in women and has adverse consequences (Flores-Mireles et al., 2015).
There are an increasing number of women with osteoporosis worldwide, thus this disease is a main public health problem amongst women. Osteoporosis causes the bones to become weakened, abnormally thin and easily broken or fractured. Osteoporosis is linked to back pain and stooped posture along with bone fracture which take place much more effortless than anticipated (Stevenson, 2018). Osteoporosis causes over 8.9 million fractures yearly, leading to an osteoporotic fracture every three seconds in the world (Jeremiah et al., 2015). Osteoporosis is prevalent across the world and it is approximated that two hundred million women suffer from this disease. Around thirty percent of all the postmenopausal women have osteoporosis in the world. The significance of osteoporosis is that it results in the fracture of the hip, vertebrae, and wrist and these fractures happen with no or little trauma (Jeremiah et al., 2015).
Some common risk factors include previous UTI’s, diabetes, pregnancy, poor hygiene, use of spermicides, recent antibiotic use, and sexual activity (Flores-Mireles et al., 2015). Whereas, some common risk factors include family history, Gonadal hormone deficiency, inadequate activity, age, low calcium and vitamin D intake, smoking, and of the Caucasian or Asian race (Aydin et al., 2014).
Health Promotion and the Screening for Urinary Tract Infections and Osteoporosis
Strategies for health promotion for women with a urinary tract infection (UTI) include screening tests to detect the infection at an early stage and behavioral counseling intended to avoid or decrease the risk factors (Aydin et al., 2014). Screening for a urinary tract infection may involve a urine culture test to detect and identify yeast or bacteria in the urine that can be causing the infection (Aydin et al., 2014). Dipstick screening test for a UTI can be performed to check for acidity, protein, blood, and glucose in urine. A urine analysis can also be used to detect the existence of the nitrites that can be a sign of a UTI (Chu &Lowder, 2018).
Conversely, health promotion for women with osteoporosis may include carrying out screening tests and offering behavioral counseling to minimize the risk factors. Screening test for osteoporosis may involve conducting a bone density test to diagnose the condition prior to the occurrence of a broken bone. Bone density test detects normal or low bone density (Hiremath et al., 2018).
Diagnostic Tests or the Laboratories Required for Urinary Tract Infections and Osteoporosis
Diagnostic tests for urinary tract infections in women include ultrasound and cystoscopy. Ultrasound is conducted to check the bladder and the kidneys for irregularities which may necessitate treatment. A cystoscopy is carried out to diagnose the cause of the recurrent urinary tract infection and assist the doctor in examining the bladder for signs of infection, comprising irritation and to identify the causes of the symptoms of the infection (Chu &Lowder, 2018). Conversely, the diagnostic test for osteoporosis is bone densitometry, which rapidly and precisely measures the density of bone to assist in detecting the condition. Another diagnostic test for osteoporosis is dual X-ray absorptiometry (DEXA) to measure the bone density of the hip and spine to assist in gauging their risk of the fractures (Jeremiah et al., 2015).
Common Treatment and Management Modalities
Not all UTI’s require treatment. An uncomplicated UTI may resolve on its own. If treatment is necessary, the first line antibiotic treatment will be dependent on the cause or specific type of bacteria that was found. First line treatment may include, fosfomycin 3g single oral dose, nitrofurantoin 100mg twice per day orally for five days, or sulfamethoxazole/trimethoprim 160/800twice each day orally for three days. The second line treatment may include ciprofloxacin 250mg orally twice daily for three days, levofloxacin 250mg orally once daily for 3 days, or amoxicillin/clavulanate 500mg twice a day orally for three days (Aydin et al., 2014). In contrast, the first line pharmacologic management of osteoporosis involves the utilization of bisphosphonates. There are pharmacological agents that are used for both prevention and treatment such as Fosamax 5mg orally a day or 35mg orally a week for prevention, or 10mg a day or 70mg a week for treatment. Raloxifene for both prevention and treatment is 60mg per day orally. For patients who are at high risk, teriparatide 20mcg daily subcutaneous for up to two years or denosumab 60mg a month for 6 months subcutaneous are productive option medications to avert osteoporotic fractures (Jeremiah et al., 2015).
The management of UTIs among women requires good personal hygiene, getting plenty of vitamin C, drinking plenty water and changing sanitary pads and tampons throughout menstruation (Chu & Lowder, 2018). In contrast, the management of osteoporosis necessitates exercise and physical activity as well as the balanced diet that consists of calcium and vitamin D supplementation, counseling the patients to quit or avoid smoking and discouraging heavy consumption of alcohol (Jeremiah et al., 2015).
Patient Education and the Follow-Up
Patient education in preventing urinary tract infection involves encouraging the patient to practice healthy habits that include good personal hygiene, drinking plenty water, getting plenty of vitamin C, understanding the causes of infection which should include changing sanitary pads and tampons often during the menstruation. The follow up for treatment along with management of urinary tract infections need to be conducted after two to three weeks to check the progress of treatment (Chu &Lowder, 2018). Conversely, patient education for osteoporosis should involve encouraging the patient to get regular exercise, eat a healthy diet and avoid smoking. The follow up for osteoporosis treatment should be performed after three to four weeks to check the productivity of the treatment plan and make necessary adjustments (Stevenson, 2018).
Health Screening and Promotion Needs for Women across the Lifespan for UTI and Osteoporosis
Health screening for urinary tract infection among women needs to involve testing a urine sample or a urinalysis. The urinalysis test is conducted to check for white blood cells, bacteria, red blood cells as well as the other chemicals including nitrites in the urine. The proper urinalysis may pinpoint the infection and the urine culture may assist the provider of healthcare to select the most appropriate antibiotic for the treatment of UTI (Gupta et al., 2017). A urinalysis and culture are carried out to see if the patient has an infection and if there is a need for further care. The urine culture and sensitivity test are the common diagnostic investigations intended to detect bacteria and to determine the kind of the antibacterial therapy required (Chu & Lowder, 2018).
On the other hand, health screening for osteoporosis should involve a bone measurement test. Early screening can help avoid osteoporosis problems in women sixty-five years and older and help detect the fracture risk factors among post-menopausal women who are younger than sixty-five years and at risk for osteoporosis as established by the formal clinical risk’s evaluation apparatus (Curry et al., 2018). Health screening should also be included in perimenopausal women with the risk factors for osteoporosis including family history.
Health promotion needs for women with the UTI should include staying hydrated, wiping from the front to the back when utilizing the bathroom, urinating often and keeping the genital area clean (Chu & Lowder, 2018). In contrast, health promotion requirements for women are engaging in physical activity and intake of calcium along with vitamin D (Curry et al., 2018).
Traditional and Nontraditional Treatment Options for Urinary Tract Infections and Osteoporosis
Traditional treatment options for a UTI involve the utilization of antibiotics that have been discussed earlier. Conversely, the nontraditional treatment plans for UTIs involve
drinking plenty of fluids
such as water and pure cranberry juice, increasing the intake of Vitamin C
and taking a probiotic
(Chu &Lowder, 2018). Traditional treatment options for osteoporosis include the utilization of medications, for instance, Bisphosphonates, teriparatide, and raloxifene. The bisphosphonates that inhibit the breakdown of bone, preserve the bone mass and augment density of the bone in the hip and spine (Stevenson, 2018). On the contrary, the nontraditional treatment alternatives for osteoporosis include acupuncture that stimulates the various organs along with body functions and promotes healing and the use of red clover, which contains estrogen-like compounds that assist in protecting the bone (Stevenson, 2018). Both traditional as well as nontraditional treatment alternatives for urinary tract infections along with osteoporosis treats the symptoms, problems of some given region and focuses on the cause and the prevention (LaRosa et al., 2016).
Nurse Practitioner Collaboration with Other Healthcare Team for the Best Practice
Interprofessional collaboration helps with offering safe and productive patient care, reduces medical errors and enhances the quality of care (Goldsberry, 2018). The nurse practitioner may collaborate with the other members of the healthcare team by sharing his or her knowledge and proficiency with others, caring for groups of patients autonomously and interdependently and supporting the other members of the team to fully utilize their distinct and shared skills (Goldsberry, 2018).
Conclusion
Both urinary tract infection and osteoporosis are widespread infections among women with numerous possible risks for complications. The appropriate diagnosis, as well as management of these illnesses, is essential to provide the best patient outcomes. The treatment of a UTI in women involves the use of antibiotics that include fosfomycin, nitrofurantoin, sulfamethoxazole / trimethoprim and ciprofloxacin. In contrast, the treatment of osteoporosis may involve the utilization of antibiotics that comprise bisphosphonates, Fosamax, Raloxifene, teriparatide and denosumab. The management of UTIs among women requires good personal hygiene, getting plenty of vitamin C, drinking plenty water, changing sanitary pads and tampons throughout menstruation. Conversely, the management of osteoporosis among women necessitates regular exercise, healthy eating and avoiding smoking. The risk factors for UTIs include diabetes, pregnancy, poor hygiene, use of spermicides, recent antibiotic use, and sexual activity. On the other hand, some widespread risk factors for osteoporosis are family history, inadequate activity, age, Gonadal hormone deficiency, low calcium and vitamin D intake, smoking, and of the Caucasian or Asian race. The collaboration between the nurse practitioner and other healthcare team helps in ensuring enhanced practice, the safety of the patients, high-quality care and enhances patients’ outcomes.
References
