WEEK 1 : Atherosclerosis and Gender.

Atherosclerotic cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Considerable research has been done over the last several decades to understand the pathophysiology of atherosclerosis. It is widely believed that estrogen is responsible for the protection of women from CVD in the premenopausal age group. However, hormone replacement therapy has failed to decrease CVD events in clinical studies which points to the complexity of the relationship between vascular biology and estrogen hormones. Interestingly, preponderance of vascular and connective tissue disorders in women also points to an inherent role of hormones and tissue factors in maintenance of vascular endothelial function. The differential effect of GPER, lipoprotein A, TLRs, leucocyte-platelet aggregate markers in men and women also suggests inherent gender-related differences in the pathophysiology of atherosclerosis. A better understanding of the pathophysiology is likely to open ways to improve evidence-based treatment of CVD in women.NURS 6051 Essay Discussions

Cardiovascular disease is the leading cause of mortality and morbidity in women after the age of 50 years in most developed countries. Epidemiology, symptoms and progression of cardiovascular disease are different in women than in men. Indeed, women develop cardiovascular disease when they are about 10 years older than men and typically after the menopause.

Risk factors have a different impact in determining cardiovascular risk in the two sexes. In men, cholesterol is more important than in women, in whom arterial hypertension, diabetes and their combination has a greater importance in determining cardiovascular risk. Menopause is an important cardiovascular risk factor both for the negative effect of ovarian hormone deprivation on cardiovascular function and for the consequent worsening of cardiovascular risk factors.

Marked gender differences also exist in the clinical manifestations of atherosclerosis and in the pattern of symptoms in the two sexes. Angina, the most common manifestation of coronary heart disease, is frequently uncomplicated in women, whereas in men it tends to evolve to an acute coronary syndrome. The clinical presentation of acute ischemic syndromes is also different in men and women and, because of the frequent atypical symptoms, women tend to underestimate the importance of them.

Because of the different impact of cardiovascular risk factors in men and women, the strategies for prevention should be different in the two sexes. In women, the control of blood pressure and glucose metabolism should be a priority. Furthermore, hormone replacement therapy may still have a role in the prevention of cardiovascular diseases if given to the right woman and at the right time.

WEEK 2 : Inflammatory Bowel Disease

Inflammatory bowel disease is the term used to describe two conditions: Chrohn’s disease (CD) and ulcerative colitis (UC).  These conditions are caused by chronic inflammation in parts of the gastrointestinal tract (GI) that includes the mouth, esophagus (that connects the throat and the stomach), stomach, small intestine, large intestine and anus. Crohn’s disease may affect any part of the GI tract but more commonly affects the small intestine. Ulcerative colitis (UC) affects the large intestine and the rectum (a small chamber at the end of the large intestine).

About 1.6 million adults and 80,000 children have IBDs.

IBD-associated arthritis is used to describe types of inflammatory arthritis associated with IBD and include psoriatic arthritis, ankylosing spondylitis and reactive arthritis.

IBDs should not be confused with irritable bowel syndrome or celiac disease although they have some symptoms in common.   NURS 6051 Essay Discussions

Causes

While the exact cause of IBD is unknown, scientists believe that the chronic inflammation is a result of an immune system that doesn’t work properly.  It becomes overactive when triggered by an environmental factor and mistakenly attacks the GI tract. People who develop IBDs are more likely to have a family member with one of the conditions.

This points to a genetic component to IBDs.

Symptoms

The most common symptoms of CD and UC are:

• Diarrhea.
• Abdominal pain/cramping.
• Bloody stools.
• Low appetite.
• Unintended weight loss.
• Fatigue.

Diagnosis

The doctor will review symptoms and medical history and perform a physical exam. Two procedures are performed: endoscopy (for Crohn’s disease) or colonoscopy (for ulcerative colitis). Imaging tests may also be performed, such as magnetic resonance imaging (MRI), computed tomography (CT) or contrast radiography, Sometimes, blood tests or stool samples are done to rule out other conditions.

TreatmentInflammatory bowel diseases are treated with five types of medications:

• aminosalicylates – These anti-inflammatory drugs include sulfasalazine, balsalazide, mesalamine, and olsalazine. They are most effective for ulcerative colitis and are given orally or inserted in the rectum.
• corticosteroids – These anti-inflammatory drugs include prednisone, prednisolone, and budesonide, and are effective for short-term control of flare-ups.  They are prescribed for the shortest time due to their side effects
• immunomodulators – These anti-inflammatory drugs include azathioprine, 6-mercaptopurine (6-MP), and methotrexate. They help to modify the disease process and tackle inflammation
• biologics – The anti-inflammatory drugs are the newest treatments for IBD. Adalimumab, certolizumab pegol, golimumab and infliximab target an inflammatory protein called tumor necrosis factor (TNF). Natalizumab and vedolizumab block certain white blood cells from affecting GI tissues

All medications come with side effects and the risks and benefits should be discussed with your doctor.

It’s common for people with IBD to get different vaccinations to help prevent infections. Surgical intervention is uncommon these days because of effective medications. But if the diseases are severe, then damaged parts of the GI tract are removed by surgery.

Self Care

What you eat can have a big impact on managing the symptoms of inflammatory bowel disease. An anti-inflammatory diet rich in vegetables, fruits, lean protein, especially fatty fish and fiber-rich foods can ease the stress on the GI tract and digestive system.  Studies show that physical activity also has anti-inflammatory benefits.  Managing a chronic disease can also be tough for your emotional health. So, develop a support network of family and friends. Also, look for ways to interact and learn from other people with IBDs through in-person support groups and online communities.

WEEK 3 : PAIN

Pain is an uncomfortable feeling that tells you something may be wrong. It can be steady, throbbing, stabbing, aching, pinching, or described in many other ways. Sometimes, it’s just a nuisance, like a mild headache. Other times it can be debilitating.

Pain can bring about other physical symptoms, like nausea, dizziness, weakness or drowsiness. It can cause emotional effects like anger, depression, mood swings or irritability. Perhaps most significantly, it can change your lifestyle and impact your job, relationships and independence.

Pain is classified as either acute or chronic. Acute pain is usually severe and short-lived, and is often a signal that your body has been injured. Chronic pain can range from mild to severe, is present for long periods of time, and is often the result of a disease that may require ongoing treatment.

Currently, the best way to treat the pain is to manage the symptoms. If the source of your pain can’t be treated, or isn’t known, our pain medicine specialists can offer options for pain control.

Pain is a word that most of us hate even to experience in life. It is a fundamental element that we feel,
When we get hurt physically or mentally. In a very small age, it is common to fall down and cry because of a slightly pain. The more we experience it the more we grow stronger in future. Physical pain is what we feel outside, It is temporary and we learn from it, The one in the inside called Mental pain can last for even a whole year and even keep us thinking. In a young age, We experience it in life such as relationship with your girlfriend, Friends, Family or even local people.

Whenever someone hurts you, you become vicious even if the person tries to help you. Lots of people try to neglect this feeling by simply being apathy. It sounds odd to do it but there are few human beings that actually do it, Whoever knows a person like that calls him crazy without knowing his past. Pain leads certain people to reach their goals because of the hard life they went through. While youngsters complain about how their relationship is conducted pretty bad, Adults take their time thinking on how to invest their money on their children. For adults it’s a huge pain, when their kids fail it shows them no hope to continue spending and it makes them get disappointed all caused by pain.

Pain is an everlasting feeling we won’t be able to change even if we feel like, it will haunt us for the good or for the bad.

In my opinion, I recommend you learn from it anytime in all sorts of ways in relationship, work, outside anywhere. The only way you defeat it is by getting stronger every day, a lot of people feel pain and give up easily without trying to get over it except talking. It seems to be unhuman to accomplish it but it is the truth if you become stronger you will gain more advantages in the future so do not take everything to heart just learn from it.NURS 6051 Essay Discussions

WEEK 4: Congestive Heart Failure

Congestive heart failure (CHF) is one of the common health challenges in aging persons. The health condition is one of the major causes of deaths and health complications for individuals that above sixty-five years. Congestive heart failure is not only a major cause of health complication and death in aging individuals but also contribute high number of re-admission among aging person. Moreover, treating congestive heart failure cost a fortune and is a major challenge to families with a CHF patient.

Theoretical framework

Considering its significance to the health of aging persons, Health care provision for aging persons should therefore consider CHF management. Because of increased cases of CHF and its health and cost implications, various recent research studies have focused towards coming up with better chf management Congestive heart failure occurs when the heart is not able to meet the body’s demand for oxygen.

The heart of congestive heart failure patient is weak and is not able to supply sufficient blood in key body organs. The condition id further accelerated by secondary factors such a as high blood pressure and coronary artery disease which weaken the heart.

Similarly, faulty heart valves, a condition that occurs when the valves between heart chambers do not open properly forcing the heart to work harder to keep the blood flowing correctly also weakens the heart leading to heart failure. Other tertiary factors such as diabetes, severe anemia as well as kidney or liver filature could precipitate to heart failure.

The symptoms of the disease are easily recognizable such as shortness of breath coughing, swelling feet and ankles, swelling abdomen as well as weight gain. The treatment and recovery require keen supervision and medication that should be regularly maintained failure to which the condition accelerates depending on the seriousness of the disease or factor involved (Stewart et al 2002, pp361)..

Literature review

Heart failure is common among the elderly and financially dependent population. These are often considered a burden to society and therefore given little attention and follow up.

The smaller financially stable population spends a considerable amount on medication and end up under cost and doctor supervision. In a community with limited or few resources there is little or no follow-up for the elderly after heir discharge from hospital.

This is because most of them often live lone and only receive one visit per week by a nurse. The nurse assesses their needs and ensures that they have taken their medicine. The regulatory and effectiveness of the medication depends on the patients discipline and punctuality in taking it (Ewald et al 2008, pp101).

The rates of discipline vary and depend on how the patient perceived the instruction on medications. This therefore poses a problem of taking medications on time. Since most of the patient lives alone, no one will remind them that a puff of cigarette or a sip of wine is a risk factor.

Medical conditions identified as risk factors to congestive heart failure include coronary artery disease, diabetes, hypertension, valvular heart disease, hyperthyroidism and earlier history of heart disease. Apart from medical conditions and age, lifestyle factors such as smoking, excessive consumption of alcohol and continuing use of anabolic steroids are noted as among risk factors of congestive heart failure.

Statement of the problem

Congestive heart failure contributes to a high number of readmission cases in elderly patients and accounts to up to a quarter of all hospitalization expenditure.

Medical scientists have noted that congestive heart failure is not only a common indication of hospitalization in elderly patients but is also linked to early deaths and a high immortality rate among these patients (Rosamond Wet al. 2008, pp146).

This study will interrogate the rates of readmission as compared to admission in a local hospital with a bed capacity of 300 patients. The study will only focus on elderly 65 and above regardless of sex, race, ethnicity, socio eco, status in life etc. admitted only with CHF and reasons ranges from non-compliance of med, no diet modification, smoking, and alcohol. NURS 6051 Essay Discussions

No younger population or any less than 65 y/o. The research will narrow down to the readmission and admission rates for the period between January 2010 and March 2011 as well as the relevant data that will facilitate the development of a case management strategy (Krumholz et al 2000, pp 476).

WEEK 5: Hypertrophic Cardiomyopathy

Heart disease is the highest reported cause of death in the United States. The Center for Disease Control and Prevention (2012), reported that heart disease accounted for nearly 600,000 deaths, even trumping cancer by approximately 25,000. Health conditions that severely damage or weaken the heart can lead to heart failure (Mayo Clinic, 2013). Cardiomyopathy is heart disease that targets the myocardium, causing it to enlarge, thicken or become rigid. The National Heart, Lung, and Blood Institute characterizes cardiomyopathy into to four different types: dilated, hypertrophic, restrictive, and arrhythmogenic. I have always found the heart to be the most fascinating organ in the body due to its responsibility of sustaining the life of every other organ. Hypertrophic cardiomyopathy is such an intriguing disease that has recently been reported in numerous instantaneous deaths of young and healthy adults. This disease interests me because I find it alarming that a disease of such an important organ is taking the lives of seemily healthy individuals. Since detection of cardiomyopathy is arduous, it is imperative to understand any minor signs or symptoms that assist with any preventative measures.

WEEK 6 : Acute Bronchitis

Acute bronchitis is the sudden development of inflammation in bronchial tubes—the major airways into your lungs. It usually happens because of a virus or breathing in things that irritate the lungs such as tobacco smoke, fumes, dust and air pollution. Bacteria sometimes cause acute bronchitis.

 

How Acute Bronchitis Affects Your Body

In acute bronchitis, cells that line the bronchi become infected. The infection usually starts in the nose or throat and travels to the bronchial tubes. When the body tries to fight the infection, it causes the bronchial tubes to swell. This causes you to cough. Sometimes it is a dry cough, but often you will cough up mucus (sputum). The inflammation also causes less air to be able to move through the bronchial tubes, which can cause wheezing, chest tightness and shortness of breath. Eventually, the immune system fights off the infection. Acute bronchitis usually lasts for 3-10 days. However, your cough and mucus (sputum) production can last for several weeks after the infection has cleared.

How Serious Is Acute Bronchitis?

Acute bronchitis is temporary and usually does not cause any permanent breathing difficulties. It is possible for people with weakened immune systems or other major health problems to develop severe problems such as pneumonia or respiratory failure. In general, those who develop major problems from acute bronchitis are:

• The elderly
• Young children
• People with other major health conditions including cancer or diabetes
• People who have not been immunized for the flu, pneumonia and whooping cough.

Bronchitis is the inflammation of the bronchi. It may develop suddenly, following a head cold (acute bronchitis), or it may continue or return regularly for many years, causing worsening of the bronchi and lungs (chronic bronchitis). NURS 6051 Essay Discussions
Certain people are more likely to get bronchitis than others. Men are effected more than women, out numbering them 10 to 1. The reasons for this are unknown. Smokers are 50 times more likely to get chronic bronchitis than non smokers.
Acute bronchitis is a bacteria or virus infection, often following a cold. People who have acute bronchitis usually have a mild fever, soreness under breast bone and coughing. First they have a dry cough then the cough later brings up green and yellow mucus. The cough may continue for 4 to 6 weeks.
In acute bronchitis, the symptoms are a head cold, fever and chills, running nose, aching muscles and maybe back pains. This is followed by a cough. At first the cough is dry and eventually becomes phlegmy.
The best treatment for acute bronchitis is bed rest in a warm room. Cough medicines will relieve the cough and aspirin will reduce the fever. Antibiotics may be needed if the cause is bacteria.
Chronic bronchitis is caused by other problems such as sinusitis, smoking etc. The Bronchi becomes thick, inelastic, and mucus and pus builds in lower part of lungs instead of bringing stuff up and out. The result is chronic cough, shortness of breath, sometimes spasm, and frequent infection.
The main symptom in chronic bronchitis is a cough. Other symptoms in chronic bronchitis rely on how much, or how little, emphysema is present. This disorder causes the lungs to become stretched, making breathing hard.

WEEK 7: Iron Deficiency Anemia and Pernicious Anemia

 

Pernicious anemia (also known as Biermer’s disease) is an autoimmune atrophic gastritis, predominantly of the fundus, and is responsible for a deficiency in vitamin B12 (cobalamin) due to its malabsorption. Its prevalence is 0.1% in the general population and 1.9% in subjects over the age of 60 years. Pernicious anemia represents 20%–50% of the causes of vitamin B12 deficiency in adults. Given its polymorphism and broad spectrum of clinical manifestations, pernicious anemia is a great pretender. Its diagnosis must therefore be evoked and considered in the presence of neurological and hematological manifestations of undetermined origin. Biologically, it is characterized by the presence of anti-intrinsic factor antibodies. Treatment is based on the administration of parenteral vitamin B12, although other routes of administration (eg, oral) are currently under study. In the present update, these various aspects are discussed with special emphasis on data of interest to the clinician.

A 52-year-old male was initially presented in an ambulatory clinic complaining of fatigue and weakness for 2 weeks. The patient also complained of frequent epistaxis secondary to nose picking for 1 month. His fatigue was accompanied by dyspnea on exertion and lightheadedness which have increased in frequency in the last 4-5 days prior to the presentation. He denied similar symptoms in the past. He reported poor appetite but no weight loss or strange craving. Other than the symptoms reported previously, the review of symptoms was negative, including neurological complaints. Complete blood count (CBC) was taken in the clinic and he was found to have hemoglobin (Hb) of 6.2 g/dL. The patient was subsequently admitted to the hospital for further workup.

Further history revealed recent upper respiratory tract infection 1 month prior to the admission. The patient’s symptoms at that time consisted of sore throat, runny nose, and low grade fever. The symptoms resolved on thier own after 5 days. There was no rash or joint pain related to the recent upper respiratory tract infection. He denied any history of bleeding disorder or any past medical history including blood transfusion. The only medication reported was Metamucil to relieve occasional constipation.

The patient was originally from Mexico. He has been living in the United Stated for the last 14 years and has not recently visited his home country. He is married and has 2 children, age 16 and 14 years, which are healthy. The patient reported that his sister and his niece may have had history of anemia but he does not know the diagnosis. He denied any history of tobacco or drug use. He admitted to drink alcohol about 6 beers per week. He works in a pastry shop as a box assembler.NURS 6051 Essay Discussions

On admission, the patient was alert, oriented, and not in any distress. Physically, he looked thin and pale. Jaundice was also noted. His vital signs were blood pressure 107/59 mmHg, pulse 76/min, temperature 98.9 F, respiratory rate 18 min, oxygen saturation 100% on room air, height 165 cm, and weight 56 kg. His cardiopulmonary examination was normal. There was no lymphadenopathy. His abdomen was soft and nontender, with no organomegaly. There was no apparent rash, skin lesion, or joint swelling. Neurological exam was unremarkable. Rectal examination revealed normal prostate and no mass palpable. Brown stool was observed and bedside hemoccult test was negative.

Repeat CBC revealed Hb of 5.9 g/dL and hematocrit (Hct) of 18.6% with normal white blood cell (WBC) and platelet count. Red cell indices were normal except for red blood cell distribution width (RDW) which was abnormally high. Review of peripheral blood smear (Figure 1) showed marked anisocytosis and poikilocytosis. Microcytosis was predominant with few large cells noted as well as tear drop cells and elliptocytes. Multiple fragmented red blood cells were also noted. WBC appeared normal. Platelet appeared low with occasional clumping. Complete metabolic panel showed elevated total bilirubin of 3.7 mg/dL with predominant indirect bilirubin level. Other values were normal. Reticulocyte count was 2.4%, but reticulocyte index was 0.4.

WEEK 8: Irritable Bowel Syndrome

This essay aims to provide a comprehensive account of the gastrointestinal disorder, Irritable Bowel Syndrome. The aetiology, pathology, and prognosis of the disorder will be described, along with details pertaining to its epidemiology. The diagnosis and management of the disorder will be described, followed by a discussion of the health implications experienced by patients and the economic costs of the disorder. Conclusions will be made based on the information and evidence discussed throughout the essay.

Irritable Bowel Syndrome (IBS), also known as spastic colon, nervous diarrhoea, and functional bowel, is one of the most common gastrointestinal disorders worldwide (NICE, 2008). It is a chronic, functional disorder of the gastrointestinal tract which is characterised by symptoms of abdominal pain or discomfort of the lower abdomen, bloating, and disordered defecation (Silk, 2003). This latter symptom can manifest in four different forms (Allison, 2002): constipation predominant; diarrhoea predominant; alternating between constipation and diarrhoea; or, non-extreme. Furthermore, although symptoms are predominantly gastrointestinal, other symptoms can include back ache, nausea, heartburn, lethargy, urinary problems, faintness, palpitations, and loss of appetite (Fortson and Lee, 2004). Symptoms are usually worse after eating and most people experience ‘flare-ups’ lasting between 2-4 days. Indeed, a key characteristic of IBS is a cycle of relapse and remission (Silk, 2003).

Worldwide, IBS affects an estimated 10-20% of the population at any one time, although the figure may be higher because not everyone seeks help for the condition (Hungin et al. 2003; Hungin et al., 2005). IBS can affect both genders of all ages, although it is twice as common in females (Voci and Cramer, 2009). It can occur at any age, but typically develops in individuals who are 20-30 years old (Wangen, 2006). Incidence tends to reduce with age (Wilson et al., 2004). Furthermore, more women report constipation predominant IBS, while more men report diarrhoea predominant IBS (Heitkemper and Jarrett, 2001). Women also tend to report a worsening of symptoms during menstruation, suggesting a hormonal link with IBS (Moore et al., 1998).

Despite there being no clear aetiology for IBS, there is a general consensus that it is a multifactorial disorder of a biopsychosocial nature (Allison, 2002). Possible factors involved in its development include an abnormality with how the muscles move food through the digestive tract, pain-sensitive digestive organs, a malfunctioning immune system, a problem between the central nervous system and the digestive system, or an abnormal response to infection. Environmental, dietary, and genetic factors that are as yet known are also suspected to play a role in the aetiology of IBS.NURS 6051 Essay Discussions

Diagnosis

A diagnosis of IBS can be made using the Rome III criteria of ‘red flag’ symptoms (Paterson et al., 1999). According to these criteria, an individual is diagnosed with IBS if they have experienced, for at least 6-months, any of the following symptoms: abdominal pain or discomfort; bloating; or, change in bowel habit. In addition, the individual has to present with abdominal pain or discomfort that is relieved by defecation or associated with changes in bowel frequency or stool formation, and have at least two of the following: altered stool evacuation (i.e. straining, urgency, incomplete evacuation); abdominal bloating (i.e. distension, tension, or hardness); symptoms made worse by eating; mucus from the rectum. Reported lethargy, nausea, backache and bladder symptoms are also indicators that might inform a diagnosis of IBS. Furthermore, there are a number of tests that are carried out to exclude other diagnoses. These include a full blood count, erythrocyte sedimentation rate or plasma viscosity (screening test), c-reactive protein (found in blood), and, antibody testing for coeliac disease (RCN, 2008).

The ‘red flag’ symptoms that require the individual to be referred to secondary care for further investigation include unintentional and unexplained weight loss, rectal bleeding, and, a family history of bowel or ovarian cancer (NICE, 2008). In people aged 60-years or over, a change in bowel habit lasting more than 6-weeks with looser and/or more frequent stools also acts a ‘red flag.’ Other indicators for referral include anaemia, abdominal or rectal masses, and inflammatory markers for inflammatory bowel disease (NICE, 2008).

Treatment

There is no cure for IBS, but it can be managed and controlled through lifestyle changes and medicine. NICE provide clinical guidelines on the management of IBS in primary care, which were developed through input from the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC). These guidelines include the provision of general lifestyle advice, particularly in terms of dietary and physical activity advice (NICE, 2008). The treatment and management of IBS is largely focused on providing individuals with the information required to self-manage their condition through diet, physical activity, and medication for specific symptoms.

Dietary advice includes having regular meals, taking time to eat, drinking at least eight cups of water daily, and restricting consumption of tea, coffee, alcohol, fizzy drinks, high-fibre foods, resistant starch (i.e. whole grains, legumes, seeds), and fresh fruit. Individuals with diarrhoea are advised to avoid sorbitol, which is an artificial sweetener found in sugar-free sweets and drinks. Individuals with wind and bloating, on the other hand, are advised to increase intake of oats and linseeds. If diet is assessed as being a key factor in the IBS symptoms, the individual is referred to a dietician for single food avoidance and exclusion diets.NURS 6051 Essay Discussions

In terms of physical activity, individuals who score low in physical activity on the General Practice Physical Activity Questionnaire (GPPAQ) are provided with brief advice and counselling aimed at increasing their activity. The importance of physical activity in the management of IBS cannot be underestimated. Indeed, a study conducted in Sweden demonstrated that even a minimal increase in physical activity can improve symptoms of IBS (n=102) (Johannesson et al., 2011).

First-line pharmacological treatment is dependent on the primary symptoms reported by the individual. For example, there is support for the provision of antispasmodic agents such as hyoscine or peppermint oil to control symptoms of abdominal pain and spasms (Ford, 2008). Laxatives are an option for constipation, whilst loperamide is the recommended first choice of antimobility agent for diarrhoea (NICE, 2008). Second-line pharmacological treatment includes the consideration of tricyclic antidepressants for mood and analgesic (pain relieving) effect if first-line treatments do not work (Bell, 2004). Selective serotonin reuptake inhibitors are considered if tricyclic antidepressants do not work. However, due to the potential side-effects of these second-line medications, follow-up after 4-weeks and then every 6-12 months is advised (NICE, 2008).

WEEK 9 : Post Implementation of EHR

Post-Implementation Assessment

Taking an inventory of the successes, and opportunities for improvement, from an EMR implementation can help an organization determine the necessary next steps. By conducting an appropriate evaluation, healthcare facilities can help shape the path of continued system customizations and improvements. Steps included in this process involve evaluating clinical, financial and operational workflows; monitoring data to assure appropriate capture and processing; and targeting the enhanced functionality to employ. Information garnered through this evaluation can be used to implement strategies to continue quality improvement.

Utilization of Data

For an implementation to be successful, healthcare organizations must effectively utilize the information obtained through their EMR system. Extracting meaningful insights when analyzing operations, monitoring trends, and tracking KPIs can be achieved through a comprehensive data analytics solution. Data integrity also has a direct impact on the quality and reliability of the organization’s reporting outputs. Many healthcare facilities leverage data obtained from a new EMR to achieve Meaningful Use incentive program requirements, participate in pay-for-performance plans, and comply with regulatory data reporting standards..

Ongoing Support and Maintenance

Although not as complex a process as an implementation, healthcare organizations will find it necessary to update their EMR system to meet changing compliance guidelines and leverage any software enhancements. Installing additional application modules, completing customizations, and functionality enhancements generally are a part of this phase. Though many healthcare facilities employ the services of an outside IT resource to guide them through an EMR implementation, few are prepared for the amount of post-go-live maintenance and support needed to address issues as they arise. Internal IT resources may not have enough time to provide the necessary support, resulting in backlogs and bottlenecks. Utilizing the services of the implementation vendor, or bringing in a consultant resource, can keep the system running more smoothly, and help users learn additional features of the system.NURS 6051 Essay DiscussionsElectronic health record (EHR) implementation, planning, training, implementation, scheduling, optimization, planning, implementation, implementation! These concepts seem to be the only words we hear buzzing around our heads when we talk about EHRs. But what about post-live? There seems to be a scarcity of conversation once the initial shock has worn off and routines start emerging. Sometimes just knowing how to use something new isn’t enough. Are you leveraging your new EHR to its full potential? Here’s an easy, low cost checklist to ensure you are optimizing your EHR.

1. Allow your super users to take a central role: Super users can help end users become more efficient right away. Often, end users are more willing to take constructive feedback and ask questions when working with a colleague versus responding to a management mandate. Super users are also on site and can be proactive by tackling minor issues before they become major problems. They can be the eyes and the ears for the analyst team when problems arise and are extremely helpful when troubleshooting issues or explaining new functionality.
2. Conduct short, e-learning sessions. These sessions can be from five to 15 minutes long, and play a key role in optimization. Because they are brief, staff remember everything they learned. They also fit easily into the workday. E-learning sessions can be interactive, which can also help the learning process. Post your sessions on your intranet as a resource so staff can “brush up” on EHR efficiency techniques (i.e., smartphrases, favorites, pref list, smartlink, etc.)
3. Review provider encounters. Periodically, review provider encounters to allow coding and compliance departments to determine if documentation and charges are being entered correctly – and whether any charges are missing. This will help you avoid any insurance corrections, reduce billing compliance risk and improve the revenue cycle.
4. Develop an optimization request process: Users are the first to recognize the need for a new EHR tool or process that can improve efficiency. Develop an electronic request process/form that can be easily completed and sent to the analyst team. These requests should then be part of a standing meeting of decision makers to review, approve and prioritize the requests. Don’t forget to communicate the execution of these requests so that users know they are being acted upon.
5. Create a monthly newsletter: Monthly newsletters are a helpful tool to communicate any changes within the EHR and to send tips and tricks for increased efficiency. Organize the newsletter by specialty so that users can quickly find information relevant to them. Include links to additional teaching documents.NURS 6051 Essay Discussions

It’s easy to consider your organization “done” post implementation, and yet optimizing your EHR is equally important and can be done cost effectively. One organization with over 55 providers hired Hayes to help with their optimization. After identifying over 60 opportunities for optimization, the group saw improvements in reporting workflows, saving the end users time, and experienced reduced number of items on their problem list, resulting in better operational functionality and better patient care. Good optimization techniques make users more efficient, save time and money, increase compliance, correct coding issues, and give users a feeling of trust and ownership in the use of their EHR.

WEEK 10 : Personal Health Information

Protected health information (PHI), also referred to as personal health information, generally refers to demographic information, medical histories, test and laboratory results, mental health conditions, insurance information, and other data that a healthcare professional collects to identify an individual and determine appropriate care.

Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and revisions to HIPAA made in 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act, covered entities — which include healthcare providers, insurers and their business associates — are limited in the types of PHI they can collect from individuals, share with other organizations or use in marketing. In addition, organizations must provide protected health information to patients if requested — preferably in an electronic PHI format.

PHI is a commodity, too. Beyond its use to patients and health professionals, it is also valuable to clinical and scientific researchers when anonymized. For hackers, PHI is a treasure trove of personal consumer information that, when stolen, can be sold elsewhere or even held hostage through ransomware until the victimized healthcare organization sends a payoff.

How personal health information is used

By its very nature, healthcare deals with sensitive details about a patient, including birthdate, medical conditions and health insurance claims. Whether in paper-based records or an electronic health record (EHR) system, PHI explains a patient’s medical history, including ailments, various treatments and outcomes.

From the first moments after birth, a baby today will likely have PHI entered into an EHR, including weight, length, body temperature and any complications during delivery. Tracking this type of medical information during a patient’s life offers clinicians context to a person’s health, which can aid in treatment decisions.

In the bigger picture, PHI can be stripped of identifying features and added anonymously to large databases of patient information. Such de-identified data can contribute to population health management efforts and value-based care programs.NURS 6051 Essay Discussions

Rules and regulations

HIPAA is the primary law that oversees the use of, access to and disclosure of PHI in the U.S. HIPAA also regulates who must adhere to these rules.

Organizations cannot sell PHI unless it is for public health activities, research, treatment, services rendered, or the merger or acquisition of a HIPAA-covered entity. HIPAA also gives individuals the right to make written requests to amend PHI that a covered entity maintains.

Partners or business associates of healthcare providers that sign HIPAA business associate agreements are legally bound to handle patient data in a way that satisfies the HIPAA Privacy and Security Rules. Business associates, as well as covered entities, are subject to HIPAA audits, conducted by the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR).

Health authorities originally intended for protected health information to apply to paper records. Since the passage of the HITECH Act and healthcare providers’ subsequent implementations of EHRs and other modern health IT systems, HIPAA has increasingly governed electronically stored patient data because providers transitioned PHI from paper to electronic formats. While the HIPAA rules regulate paper and electronic data equally, there are differences between the two formats.

First, patients who submit a request for access to their data must have that request answered by a covered entity within the 30-day period, a timeframe that was created to accommodate the transmission of paper records. The disposal methods of PHI also vary between electronic and paper records. Paper files can be shredded or otherwise made unreadable and unable to be reconstructed. Electronic PHI should be cleared or purged from the system in which it was previously held.

Privacy and security standards

HIPAA splits PHI specifications among its Privacy and Security Rules. The privacy regulations govern how hospitals, ambulatory care centers, long-term care facilities and other healthcare settings use and share PHI. Meanwhile, the security provisions cover measures, including software, that restrict unauthorized access to PHI.

Covered entities must evaluate IT capabilities and the likelihood of a PHI security risk, but the types of technology aren’t specified. Such actions would include steps to thwart hackers and malware from gaining access to patient data.NURS 6051 Essay Discussions

The new data privacy law in the European Union, known as the General Data Protection Regulation (GDPR), affects PHI on a wide scale. GDPR generally applies to health data, including genetics, so healthcare organizations that treat EU patients will need to be cognizant of GDPR’s regulations about patient consent to process PHI.Also, in March 2018, the Trump administration announced a new program called MyHealthEData, in which the government promotes the idea that patients should have access to their PHI and that such data should remain secure and private. The underlying point of MyHealthEData is to encourage healthcare organizations to pursue interoperability of health data as a way of allowing patients more access to their records.

Common misconceptions

A sometime-misinterpreted situation is that PHI privacy and security do not always move in tandem. While privacy under HIPAA necessitates security measures, it is possible to have security restrictions in place that do not fully protect privacy under HIPAA mandates, attorneys have noted. For example, if a cloud vendor hosts encrypted PHI for an ambulatory clinic, privacy could still be a liability if the vendor is not part of a business associate agreement. Under HIPAA, the vendor is responsible for the integrity of the hosted PHI, not just its security.NURS 6051 Essay Discussions

WEEK 11 : Federal Drug Administrion

The Food and Drug Administration Abstract This paper aims to discuss the way the U. S Food and Administration department makes its rules and how the agency implements them. It also presents an analysis of the enforcement process in the United States and gives a way forward on the improvement in the enforcement of the law. Introduction Body Background of the Food and Drug Administration. How the FDA makes it rules Types of rules How the agency implements the rules Analysis of enforcement process f) Conclusion Background The Food and Drug Administration is a scientific agency of the U. S.

Department of Health and Human Services that oversees the regulation of food products, human and animal drugs, medical devices and radiation among other public health products. FDA was established in 1906 to establish a foundation that would foster comprehensive, and science-based protections that ensure the highest quality of products essential for health and survival in America. The department grew from a single chemist in the U. S.

Department of Agriculture and eventually became attached to the Department of Health and Human Services, as FDA in 1953. The agency boots of an administrative capacity of about 9, 100 employees within and outside of the Washington D. C. 1 On its work-list are chemists, pharmacologists, physicians, microbiologists, veterinarians, pharmacists, and lawyers, among others. How the FDA makes it rules FDA is a regulatory agency like many others in the U. S. As an agency it is empowered to create and enforce rules and regulations that carry the full force of a law.

Violation of its rules or regulations by individuals, businesses, and private or public organizations often results into sanctions, imprisonment, forced closure or fines undertaken by the regulatory bodies with support from government bodies. 2 Rules are defined as a part of an agency statement of general or particular applicability and future effect designed to implement, interpret, or prescribe law or policy or describing the organization, procedure, or practice requirements of an agency according to web Regulatory bodies supervise operation of several sectors like banking, health, environment, education and energy in most economies. The following are some of the laws that the agency uses to ensure public safety: Sec. 1. Manufacture of Adulterated food or drugs, Sec. 2. Interstate commerce of adulterated goods, Sec. 3.

Rules and regulations, Sec. 4. Chemical Examinations (of foods and drugs), SEC. 9. Guaranty from manufacture and Sec. 10. Seizure of original packages. 3 The agency also has enforcement jurisdiction for provisions of these laws; Fair Packaging and Labeling Act (FPLA), Public Health Service Act (PHSA) and Public Health Security and Bio-terrorism Preparedness and Response Act. 4 Other examples of regulatory agencies that enforce public health safety measures include; the Administrators In Medicine (AIM), Federation of State Medical Boards (FSMB), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Medicaid and Medicare and United States Department of Health and Human Services. 5 The rules that implemented by these agencies are commonly discussed and passed by the Congress. In other countries, it is the obligation of parliament to pass the laws by which the regulatory agencies should govern their areas of concern. 6 In addition, rules are not created randomly considering the impact of their outcome on the public. The rules are formed with the publics help.

All citizens are given chance to submit their thoughts about the rules proposed by the FDA, before the Congress endorses them. The department offers telephone numbers and e-mail addresses to consumers to facilitate communication between it and them according to the departments website. 7 In America, the FDA is the primary regulatory agency impacting the food industry with regard to food safety, food adulteration, and food labeling or misbrand ing. However, majority of the food-related regulatory activity is within the Center for Food Safety and Applied Nutrition according to the FDA website web The agency inspects and regulates domestic and imported food (including shell eggs, bottled water, and wine beverages with less than 7 % alcohol) sold in interstate commerce, except meat, poultry, and processed egg products (which fall under the Usda’s Food Safety and Inspection Service) according to the FDA website. Its responsibility covers the Federal Food Drug & Cosmetic Act (FDCA), Nutritional Labeling & Education Act (NLEA); and Dietary Supplement Health & Education Act (DSHEA) federal acts in addition to the one mentioned above. Under authority of the Federal Food, Drug and Cosmetic Act (FDCA), the FDA has primary jurisdiction for the prevention of adulteration and misbrand ing of foods, drugs, and cosmetics sold in interstate commerce. Food is considered adulterated if it contains a residue of a physical, chemical or microbial agent at an unsafe level.

In addition to the presence of an unsafe level of a substance, a food is also considered adulterated under the FDCA if a food product is deemed to be prepared, packed, or held under unsanitary conditions or has not been manufactured under current Good Manufacturing Practices or economically damaged. 8 Packaged food is considered misbrand ed when the label or labeling is considered false or misleading, or if it is not labeled in accordance with FDA labeling regulations (7). Also when the packaged food products are not in conformity with have appropriate nutrition information in accordance with the Nutritional Labeling and Education Act (NLEA). It is also mandatory that dietary supplements must be appropriately labeled in accordance with the Dietary Supplement Health and Education Act (DSHEA). 9 Enforcing the rules The FDA administers its rules through Americas 57 States. Contracts to enforce the rules are awarded through tenders to the various states. Under these contracts, the states conduct more than 188, 000 compliance checks according to web For example by close of FY 1998, FDA had signed contracts with 43 states and territories totaling $ 16, 382, 912.

Under these contracts, the states conducted more than 188, 000 compliance checks by September 30, 1999 according to the Department of Health and Human Services. 10 In bid to achieve publicity among the consumers and other stakeholders in the states, the agency designs a comprehensive outreach program, which informs and ensures compliance to the rules it sets. The campaign includes advertising, direct mail, press events, exhibitions, speeches and on-line information dissemination according to web FDA also publishes rules that establish regulation of foods, drugs, biologics, cosmetics, radiation-emitting electronic products, and medical devices. According to Elder, (2006) FDA conducts inspections and surveillance of establishments throughout the nation, at ports of entry, and in foreign countries, to enhance safety and integrity of the products in America. In addition, the agency gathers and analyses samples of products to determine their safety, effectiveness, quality, purity, and truthfulness of labeling. In addition, the agency chemists and inspectors, the agency carries out its work with the help of laboratories and inspection offices spread around the nation.

Their work is facilitated by thorough research and study, and resourcefulness that have helped them meet technology advancements in product and manufacturing technology. Agency scientists also evaluate applications for new human drugs and biologics, complex medical devices, food and color additives, infant formulas, and animal drugs. Also, the FDA monitors the manufacture, import, transport, storage, and sale of about $ 1 trillion worth of products annually at a cost to taxpayers of about $ 3 per person. Investigators and inspectors visit more than 16, 000 facilities a year, and arrange with state governments to help increase the number of facilities checked. 11 As part of the agency’s broader initiative to ensure the safety of the public, FDA prohibits through warning letters, manufactures and distributors of unapproved drugs that could endanger the lives of Americans. For example on March 1 2007, the FDA told 20 companies to stop marketing unapproved drug products containing ergot amine tartrate.

This followed the discovery of unapproved drugs that pose a real risk to the American public and the need by the agency to ensure a safe and effective drug supply for the American public. FDA also urged consumers who were using ergot amine products to ask questions regarding their health care provider. For example, the FDA issued a warning letter to Aventis Pharmaceuticals of Bridgewater, N. J. , last November after milder notices about ads for its cancer drug Taxotere failed to produce what the agency considered an adequate response. 11 When an individual (s) or companies fail to meet the requirements of the agency, it takes a range of disciplinary actions against them. The penalties that took shape in 1956 are administered to the culprits. These include seizure, injunction, disqualification of clinical investigators, civil money penalty cases, examples of the types of Warning Letters issued, and recalls and prosecution. NURS 6051 Essay Discussions

For less serious, less threatening breaches, informal means are used to achieve compliance. More formal written warnings are issued in other situations where prompt corrections are expected to achieve full compliance with the law. Violators who do not heed these warnings, however, or whose actions pose a more serious public health risk may be subject to more formal and severe measures. 12 In a nutshell, FDA extensively carries its work and has succeeded almost all its efforts over the years however; it does not comprehensively meets its administrative roles because of certain limitations. This is because it lacks adequate manpower and often leaves its work to a few people who are often overwhelmed by the bulk of work. In his article, FDA struggles to police Print ads for Prescription Drugs. Pugh (2006), says because the FDA is understaffed, drug ad campaigns are sometimes over before the agency’s watchdogs spot a faulty ad.

When the FDA does object, drug companies sometimes respond slowly or incompletely, with the same result: Consumers are left with misleading impressions of how safe and effective advertised drugs are. On another occasion, only 18 FDA reviewers were assigned to scrutinize the roughly 37, 000 drug ads and promotional materials that drug companies submitted last year. The manpower was half the required manpower and thus could not produce adequate reviews that were required by the department. Pugh also reveals that drug companies have little motivation to respond quickly to FDA complaints because the agency isn’t using the legal authority it has to seize drugs or take violators to court. Instead, the Bush administration says proposed sanctions must pass a new review by the FDA’s general counsel.

Congressional investigators say that slowed efforts to crack down on dubious ads. In my opinion, I think decisions made by the FDA should be independent of any of the Bush administration. Simply because the FDA is conversant with the environment within which it works and is free from economic pressures. The department needs to hire more scientists to administer its regulation and enforce the rules it makes. Further strengthening should be done through development in the departments technology know how since theres an evolution of products and birth of new ones almost every other new day. The department should also hire sound media monitoring agencies to closely monitor advertisers of products that do not conform to its laws.

By so doing, it will improve its capacity to limit the unapproved food and drug products from getting sold on the market. The end result will be better and less endangered lives of most Americans. ? Bibliography 1. David, K. Elder (1956). The Enforcement story / The Impact of the Food and Drug Administration on Our Society, Published by MD Publications, New York. 2. NURS 6051 Essay Discussions