Case 2. Understanding how bacteria in the gut shape allergy and asthma risk.

The microbes that naturally colonise the digestive tract of very young infants may affect their risk of developing childhood allergies and asthma. Recently, scientists identified several patterns of microbial communities in the stool of infants aged 16 to 137 days old. Every pattern of organisms potentially results in a different metabolic environment in the gut based on what the organisms produce as they grow. One particular pattern of microbes in these infants appeared to influence immune cell populations and promote the development of allergy and asthma. Newborns at highest risk for allergies and asthma had an increased abundance of specific fungi and had a lower abundance of certain bacteria compared to those at lower risk. Exposing healthy immune cells to a bacterial metabolite called 12,13-DiHOME (present in higher amounts in the stool of the infants who were at high risk to develop allergies and asthma) caused a decrease in allergy-protective cells and an increase in allergy-promoting cells. Translocation of microbial products (metabolites) through permeable brush borders of the intestine is linked with altered inflammatory responses that may drive pathways for allergic asthma.

Please help with question 1 and 2

1. How would you use a potential biomarker to determine allergy/asthma risk associated with gut bacteria?

2. Write up a SOP for your biomarker assay.

Complete drug card-

Generic /brand name

Category class

expected Pharmacological Action

Complications

Contraindications/Precautions

Interactions

Medication Administration

Evaluation of Medication Effectiveness

Therapeutic Use

Nursing Interventions

Client Education

1. Lanoxin

2. Furosemide

1)patient has low serum albumin with dependent edema. he is to receive 2 units of seeum albumin iv. the reason for this is given to

a)decrease bp
b)improve nutrition
c)lower hydrostatic pressure
d)pull water back into the vascular bed

a) after receiving the albumin will the patients urine output increase or decrease??

b) after receiving the albumin what will happen to the colloid osmotic pressure??

1. Explain the advantage of Fc fusion protein drugs.
2. Why would it be a bad idea to give an immunosuppressed patient a live attenuated vaccine?
3. Why might an antibody to one serotype be ineffective against a different serotype (antigenic variation)? just short answer

Using outside research sources, describe the similarity and differences between telehealth and telemedicine in the health care provider workplace. What are the positive and negative aspects of telehealth nursing? What impact is telehealth reimbursement in the current environment having on the long term development and implementation of telehealth initiative within a physician provider or health care or hospital setting? What is your outlook for continued usage and success/failure of telehealth after the current pandemic slows? Support your theory with financial analysis and data.

Draft a list of Structured interview questions based on a clinical trail as a topic.

This is towards understanding for structured vs. unstructured interview types.

Draft about 10 questions for a structure interview please. The questions should be things that an interviewer to ask a participant (who will be a patient that want to be a participant in a clinical trail).

Draft a list of Unstructured interview questions based on a clinical trail as a topic.

This is towards understanding for structured vs. unstructured interview types.

Draft about 10 questions for a Unstructured interview please. The questions should be things that an interviewer to ask a participant (who will be a patient that want to be a participant in a clinical trail).

Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy's past medical history includes a knee replacement. Their support system includes Julia's son, Neil, and Lucy's niece, Nora.
The introductory monologue takes place in Julia's home prior to an initial home health nurse visit. In the monologue, Julia discusses her life, including raising a son to adulthood, then meeting Lucy. She reviews her history with cancer and relates her understanding of home hospice care and her desire to die at home. She expresses concern about leaving Lucy alone.
The scenarios begin with the home health nurse evaluating Julia after she has decided to stop treatment for her lung cancer. Her partner Lucy wishes to care for her in their home. In the second scenario the end of Julia's life is near and she is surrounded by her loved ones and the hospice nurses. Julia dies during this scenario. The learners are introduced to supportive measures for both the patient and the family during this process. The final scenario concentrates on Lucy and the difficulties she has adjusting to her new life after Julia is gone. The objectives focus on the students' assessment of Lucy's grieving process, how well she is coping, and the physical changes that she has experienced over the past few months.
Scenario 1 involves a visit by the home health agency nurse. Learners are expected to complete a physical and functional assessment of Julia and her nursing care needs, as well as an assessment of the home with a focus on safety. Julia inquires about hospice services, but her son, Neil, urges her to try one more round of chemotherapy. Lucy is supportive of Julia's decision and tries to comfort Neil. Learners will assess Lucy's caregiver strain, and articulate what hospice care means for the patient and family. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, the Katz Index in Activities of Daily Living, and Informal Caregivers of Older Adults at Home: Let's PREPARE!
Scenario 2 takes place in the home two months later. Julia is barely responsive and has Fentanyl patches for pain. Nursing care consists primarily of performing an appropriate patient assessment and ensuring patient comfort. Julia dies during this scenario and the learner provides support for the family. During debriefing, discussions may include how nurses manage their own emotions and self-care after the death of a patient.
A second monologue occurs three months after Julia's death. Lucy is in the emergency room. She is grieving and wants to talk about Julia and their life together. She feels very lonely, but has had some contact with her neighbor, Adele, and her niece, Nora. There have been other instances where she has become anxious, dizzy, and slightly confused, stating that her heart was pounding and she felt like she "can't walk or do anything." Lucy thinks she has called 911 "about once a month since Julia died" and was transported by ambulance to the emergency department.
Scenario 3 takes place in the emergency department. Lucy called 911 once again after another fall at home. Her blood pressure is slightly elevated. Otherwise, Lucy is found to be in good health. Objectives relate to assessing her safety, her fears, the grieving process, and her need for assistance at home. The assessment tools recommended for this scenario include SPICES, The Hendrich II Fall Risk Model, the Geriatric Depression Scale, and the Generalized Anxiety Disorder 7 (GAD-7).

Finish the Story:
Learners have now seen Lucy at four snapshots in time. What do they think her life will be like three months from now?

For an entire week (7 days total), keep a record of your activities in a time log. Use the categories in the Schedule Calculator as a guide for how to label the activities. You may download the Time Log file and use it to keep track of your hours, or use whatever method works best for you. There should be a page or table for each day with the day identified at the top. You may start on any day of the week that you wish, but you need to plan on starting this assignment at least 1 week before the due date. For each day, fill in the summary information for how much time was spent in each category. If an activity can be applied to more than one category, only count it in one category. For example, eating dinner with family should be included in either Eating or Family Time but should not be counted in both. Do not include study time in the summary as your study time will be calculated when you fill out the schedule calculator. Each entry in the table corresponds to 1/2 hour and make sure that you don't have more than 24 hours in the day.

I remember being handed a white coat during my first year of medical school. It came crisply folded in a cellophane bag. I was told to wear it anytime we were in the hospital or with patients as a sign of respect.

There was no pomp about it. I took it home and tried it on. It was like putting on a costume and pretending to play doctor. The white coat continued to feel that way to me for a long time.

Over the years, the costume has become second nature and part of my clinical identity. I slip it on when I'm seeing patients, because when I've asked, most of them tell me they prefer it. The coat provides a mutual comfort to us both.

My, how times have changed. Now the vast majority of the nation's medical schools (along with more than 700 nursing schools and physician assistant programs) host special white coat ceremonies, in which new students are welcomed into their profession with a solemn ceremony invoking commitment to the healing arts. White coats are formally offered to students, and put on them by their school's leadership.

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These ceremonies present an opportunity for the students and their families to mark the beginning of health careers in an educational and professional crucible that will challenge their ideals, empathy and compassion. "The iconography, the ritual of holding up members of the profession in this time of change must be maintained," says Dr. Richard Levin, president and CEO of the Arnold P. Gold Foundation, whose mission is to promote and maintain humanism in health care.

Now in the role of medical educator myself, I find anything that helps students stay connected with their highest ideals valuable in imparting a sense of professionalism. That's why it's disconcerting to think that our white coats are being challenged as possible vectors of infection.

A group of doctors in the field of infectious diseases has begun to rally around a mantra of "bare below the elbows," suggesting that health professionals avoid wearing white coats altogether, as is the custom in the U.K.

It turns out we don't wash the things nearly enough.

In a piece titled "It's Time for Doctors to Hang up their White Coats for Good," Boston-based infectious diseases specialist Philip Lederer argues that white coats have outlived their usefulness, both as guardians of cleanliness and as symbols of the profession.

Studies demonstrate the presence of harmful bacteria on our white coats, though evidence of direct harm to patients is lacking.

"We don't need a randomized trial to prove that parachutes save lives," Lederer told me. He prefers wearing khakis and dress shirts with the sleeves rolled up; no tie. He mentioned other docs who favor vests for their pockets and warmth, a trend some hope will catch on. And while Lederer supports the idea of a humanism-themed ceremony to welcome students into the profession, he and others suggest that even as a symbol white coats are more of a barrier than a conduit to strong doctor-patient relationships.

Levin counters that with all of the changes in health care, people in the field feel a tremendous sense of dislocation. "The idea of taking away [professional status] rather than elevating it is a problem for health care," he said. But taking away the coats wouldn't necessarily be a blow, he said, pointing to a study that challenges the notion that white coats are fundamentally elitist.

The debate over white coats has forced me to consider my own practice. In the end, I think the issue is as much about generational change as it is about infection control. I'd give up my white coat instantly if I knew it was spreading harmful bacteria. But colonization with bacteria is different from transmitting them to another person.

Bacteria live on all of us, so are white coats necessarily worse than our other garments or even our own skin?

It's likely that this debate will continue, unless patients were to somehow come to consensus on what they want doctors to wear. And that's not likely to happen anytime soon.

Until then, I vow to wash my white coat more frequently.

1. Does the White Coat Ceremony give a false impression to the participants and the public that these students are now full-fledged physicians? Can you see where this might encourage elitism?

2. Rather than being initiated into a “patient-centered ethos” through the process of the ceremony as reported by the Arnold P. Gold Foundation (Wiley and Allen 2015:53), could these first year students be party to appropriation of a prestigious image they are totally ill equipped to claim at this point in their education? Can you identify how this might be harmful to both student and others?

3. Is the “coat” a case of elitism or something more ominous and mistakenly mundane like the spread of microorganisms to sick and sicker people?

4. Does this ceremony further cultivate a defining line between patient and power? Is the patient disadvantaged by the symbolic nature of the “white coat?”

Case 32: Heck No, I Won’t Go! I’m Not Covering for Free!

On Thursday night Dr. Jones was at home watching television and spending time with his family. The phone rang. The South Shore General Hospital ER physician asked him to see an urgent patient. Dr. Jones replied that he was not on call for the emergency room at South Shore General Hospital, and furthermore, the hospital was paying members of a competing group to cover the emergency room. The emergency room doctor said that he was aware of the arrangement with the competing group. However, the ER could not reach the on-call physician and had tried for some time.

Dr. Jones, who earlier had a glass of wine with dinner, responded, “You’ll have to keep trying. I’m not coming in.”

The next day Dr. Jones called the Chief of Staff and the Chief Medical Officer (CMO) of South Shore General Hospital and informed them that neither he nor any members of his group would cover the ER unless they were compensated in a similar manner to the competing group and had an appropriate contractor arrangement with the hospital. Dr. Jones asked the Chief of Staff and CMO if they worked for free. Dead silence. “While you’re thinking about that question, let me say this to both of you. Doctors are working harder and longer hours and earning less money every year. Why should we give up our free time and work for nothing when you’re willing to pay the other group?”

CASE WRITE UP (PLEASE INCLUDE DETAILED EXPLANATION AND COMPLETE )

* PLEASE BE ADVISED THAT MY ROLE FOR THIS CASE IS CHEIF MEDICAL OFFICER

- Alternatives and Recommended Solution

- Evaluation

THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!! --- I NEED Alternatives and Recommended Solution & Evaluation part done

Case Write-Up

Background Statement

A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.

Major Problems and Secondary Issues

The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.

Your Role

In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.

Organizational Strengths and Weaknesses

As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”

Alternatives and Recommended Solution

As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.

Evaluation

If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.

If you were audited by OSHA, how would you prove the assessment has been performed if you did not have anything in writing? Do you believe justification of the hazard assessment proves the point?

As reproductive technology increases, pregnancies from sperm and egg donations are more common. What information should sperm and egg donors supply to future potential children?