Human experience across the health-illness continuum
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Human experience across the health-illness continuum
The benchmark assesses the following competency:
Benchmark: 5.1. Understand the human experience across the health illness continuum.
Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:
Examine the health illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
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Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).
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Physical Assessment Analysis
Order Instructions: All I need is 1 to 2 paragraph of analysis findings of a physical assessment of a 50 yrs male, height 5ft 9in and weights 270lbs with a medical history of GERD and a hernia in his esophagus. No chronic diseases. My recommendations is to see his PCP on overweight.
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Bloom Taxonomy
The present health care system dictates that delivery processes integrate various interfaces and patient handoff amid myriad health care practitioners with different levels of educational and professional background. During the timeframe of a four-day hospital stay, a patient might come into contact with 50 different personnel, including doctors, clinicians, technicians, and others. Dynamic clinical practice thus includes many cases where essential information should be correctly communicated.
Team cooperation is critical. When health care specialists are not communicating productively, the safety of a patient is at risk for various reasons: insufficient essential information, mix-up of information, ambiguous orders over the telephone, and ignored adjustments in status. Poor communication leads up to circumstances where medical errors can take place. These mistakes have the capacity to amount in severe injury or surprise patient demise. Medical flaws, particularly those caused by lack of communication, are widespread challenge in today’s health care organizations.
Conventional medical education stresses the significance of a practice that is free from errors, using severe peer pressure to accomplish perfection at the time of diagnosis and treatment. Mistakes are thereby conceived normatively as a harbinger of failure. This situation generates an atmosphere that prohibits the fair, honest assessment of errors needed if organizational learning is to occur.
It is significant to stress that nurturing a team cooperation environment may have problems to solve: extra time, conceived loss of independence, lack of confidence, conflicting ideas, amid others. However, many health care personnel are aware of the poor communication and teamwork, as a consequence of a culture of truncated outcomes that has bloomed in many health care situations (Helmreich and Schaefer, 2009).
Bloom Taxonomy
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According to Irwin, McClelland and Love (2006)communication is the core factor in medical care. In essence communication between physicians and patients is amassing a growing amount of attention with the health care in the U.S. In the last few years descriptive and investigational research has attempted to focus on the communication activities during medical consultations. Nevertheless, the knowledge obtained from these endeavors is restricted. This is likely because amid inter-personal relationships, the physician-patient collaboration is one of the most sophisticated ones.
While advanced technologies could be utilized for medical diagnosis and treatments, interpersonal communication is the key apparatus by which the doctor and the patient trade information (Stiles & Putman, 2007). Particular factors of doctor-patient communication appear to have considerable effect on patients’ attitudes and safety, for instance, contentment with care, positive response to treatment, recall and having knowledge about medical information, dealing with disease, qualify of life, and even condition of health.
Cooperation and communication are particularly essential in the case of a chronic disease, such as a cancer (Fallowfield, Maguire & Baum, 2002). Today, specialists of communication have progressively been focusing on psychological features of cancer. Creating a proper inter-personal cooperation between physicians and patients can be interpreted as a significant function of communication.
Furthermore, proper inter-personal relationship forms the basis for optimum medical care. On the other hand, the significance of a good physician-patient relationship relies on its therapeutic qualities. Another key function of medical communication is supporting the exchange of information between the physician and the patient.
Bloom Taxonomy
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Information can be regarded as a resource brought into the verbal exchange between the two parties. From a medical standpoint, physicians need information to determine the correct diagnosis and treatment strategy. From the patient’s standpoint, two needs have to be accomplished when meeting with the physician: the need to know and understand and the need to experience a sense of being known and understood. To be capable of achieving doctor’s and patient’s needs, both alternate between information-transmission and information- hunting.
Patients have to provide details about their symptoms, physicians’ needs to considerably look out relevant information. At times patients may be inclined to ask for as much information as possible, doctors appear to know patients needs for information. For instance, where cancer is involved, the desire for information is most great. A great number of cancer patients’ discontentment with transmission of information emanates from concordance between views of patients and physicians.
When relaying information to cancer patients about their disease (good or bad), doctors might explain medical information more empirically while patients explain it as a matter of individual relevance. As a consequence, the doctor might experience a satisfying sense that he has offered right and relevant information. The patient conversely might feel he has discovered nothing satisfying. Recent research indicates that about 45 percent of cancer patients have reported that no information has been provided relating to dealing with their disease (Fallowfield et al., 2002), however most patients wanted such information. Doctors must thereby first motivate their clients to exchange their key worries without interruption (Ben-Sira, 2008).
Bloom Taxonomy
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Psychological privacy involves a patient’s capacity to be in charge of active and cognitive inputs and outputs, to think and formulate behaviors, values to establish with whom to share information. Nevertheless, asking delicate questions and divulging confidential information is inevitable if the physician desires to find an effective diagnosis and treatment. The degree to which doctors communicate in a more dynamic, high-regulation style, could be conceived by patients as abuse of their psychological privacy. Physicians’ attitudes during patient examinations are regulated by societal values. It seems that at the time of medical interactions limited privacy is needed.
Constant eye contact, for instance, could be viewed by the patient as excessively intimate for the relationship. Conversely physical privacy can be regarded as a relevant aspect of non-verbal communication and can lead to improved quality of the inter-personal interactions between physicians and patients (Stiles and Putman, 2007). Other result gauges utilized to examine the quality of the physician-patient interaction are patients’ recall and understanding information. As it stands, most patients fail to recall or comprehend what the physician has told them.
Patient compliance is also a broadly utilized result variable and is regarded a measure of the productivity of provider-patient communication. Doctor-patient interaction might have significant outcomes for patient’s health outcomes, thus this relationship can be viewed as a type of social support. Lack of information appears to play a vital function in psychological challenge that can come up during the diagnosis and treatment (Irwin, McClelland & Love, 2006).
Bloom Taxonomy
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References
Ben-Sira.Z. (2008). “Affective and instrumental components in the physician patient relationship: an additional dimension of interaction theory.” Journal of Health Sociological Behavior, 170-185.
Fallowfield. L. J., Hall A., Maguire. G. P. and Baum. M. (2002).“Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial.” British Medical Journal, 301- 575.
Irwin W. G., McClelland R. and Love.A. H. G. (2006). “Communication skills training for medical students: an integrated approach.” Medical Education, 387-390.
Stiles. W. B. and Putnam. S. M. (2007).Analysis of verbal and non-verbal behavior in doctor-patient encounters: In Communicating with Medical Patients. Newbury Park, CA: Sage Publications.
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Appendix: Interview
I chose to interview a personal acquaintance of mine who happens to be a screenplay enthusiast. I think it is a fantastic occupation path since it balances creativity and professional writing.
1. What are you pursing as an undergraduate student?
I am studying Journalism.
2. How will your undergraduate studies influence your future career?
I am on track to work in the corporate world, probably as an editor
3. When did you first develop interest in screenplay writing?
I like to think when you first write a screen-play and gets positive comments from people who have been in the production scene for some time, you get interest in that moment. It had never occurred to me that this was something I’d be doing as pastime thing.
4. How much experience with screenplay writing do you have?
None as a matter of fact, but I have always been involved with creative writing on the side (for instance, poems and flash stories).
5. What are some of your objectives for the future?
Finishing my undergraduate, find a job, get a job, and see what fate throws my way. I have come to discover in life that whatever you make plans, the big guy above somehow has a totally different idea.
6. Would say that screenwriting you will be engaged in as a side project rather than a full time career?
I don’t want to find myself restricting myself at all. My undergraduate will put me up in the corporate world, but this might as well turn into an amazing gig in the future.
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Determinants of health and ways they impact persons health
Introduction
To improve the health status of the community, there is need to reduce the health inequalities. This is only achieved by understanding factors that promote as well as protect health of the community, which are commonly referred to as determinants of health (Fane & Ward, 2014). These determinants are categorised into social, cultural and economic factors.
This is important because despite the fact that the USA government is spending fortune in medical care, the health outcomes still remains low than most of the developed countries. In fact, the USA IS ranked the 34th in infant mortality in the world (Potter, Trussell, & Moreau, 2009).
However, it is possible to envision the more promising end of this medical story if number of strategies are employed to understand as well as promoting the health of the community. This is achieved through analysis of health determinants as outlined by logic models (Blanchard et al., 2013).
These models are important because they are oversimplified and approximate, thus helping the identification of complex interplay, which would be important in taking action to improve the health of the population, which are developed by the new framework of health goals for USA, commonly referred to as “ Healthy People 2020 (Fane & Ward, 2014).”
This paper summarizes the main sociocultural and economic determinants of health and ways they impact the health of a person, leading to inequalities. Understanding these determinants is important because it helps improve the health of the community, thereby reducing healthcare inequalities. This aid in the identification of the specific areas for actions, which also facilitates the identification of the most feasible interventions that could aid promote quality care.
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Determinants of health
Evidence based study indicates that certain healthcare behaviours affects personal and community health. These includes behaviours such as smoking, poor nutrition, physical inactiveness, and excessive alcohol consumptions. Similarly, the amount of household income, educational achievement, ethnic background, employment and neighbourhoods also associated with profound effects of health (Perrin, 2013).
To start with, income and wealth determinants impact the health of a person. Research indicates that increased income improves the health outcomes. However, the relationship between health and income is not linear (Potter, Trussell, & Moreau, 2009). This is because money itself does not translate into good health. Instead, wealth is generally considered to give someone position within the society, which makes them, have better access to better economic opportunities (Salt, 2014).
This makes them live in healthy and safe communities, with better equipped facilities. Additionally, they are able to afford health insurance, and thus can access health more easily. Most have great amount of wealth and assets such as savings, low debt and high amount of savings that can be disposed to meet the health demands of the person where necessary (Blanchard et al., 2013).
Conversely, poor people are restricted to these amenities and are often exposed to environments that are health damaging. They lack sufficient amenities such as recreational facilities, grocery stores or even health care facilities (Fane & Ward, 2014). These people will lack social supports or relationships, have poor self-esteem, lack sense of control and are more likely to suffer from chronic diseases and acute stress. This impact is particularly vital in children and infants. Low income is associated with increased infant and childhood mortality.
It is also suggested that the hardship and economic deprivation in childhood significantly affect the adult health (Fane & Ward, 2014). Thus, children in low income households are more likely to suffer from poor nutrition, which results to health complications in their adult life including obesity, cancer, mental health, and cardiovascular diseases. This forms a vicious cycle of poverty and health (Potter, Trussell, & Moreau, 2009).
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The link between socioeconomic factors and health is clearer. However, the communities in which people live also influences their health. Literature indicates that people living in poor neighbourhoods report higher mortality rates, high incidences of chronic diseases and poorer health standards as compared with people living in safer neighbourhoods (Potter, Trussell, & Moreau, 2009). One study conducted in Wake County, North Carolina indicated that people living in poorer neighbourhoods reported higher incidences of pre-term birth, greater levels of depression, high level of teen pregnancy and increased resistance and disorders among the adolescents (Fane & Ward, 2014).
Additionally, different neighbourhoods makes it difficult to access healthy food, availability of parks and sidewalks and open spaces where people can exercise. The proximity of the people to environmental hazards also influences the quality of care (Diaz de León-Castañeda, RamÃrez-Fernández, & Pinzon Florez, 2013).
Housing also influences the health being of an individual. Living in houses that are poorly ventilated, damp, overcrowded or with poor waste disposal strategies are associated with increased diseases, communicable infections and other preventive diseases (Salt, 2014). Housing structures are very important as people spend approximately 90% of their time within their home, and thus poor housing can put people at risk of developing health complications due exposure to environmental hazards (Fane & Ward, 2014).
Additionally, overcrowding increases the risks of transmitting infectious diseases such as tuberculosis as well as other respiratory diseases (Blanchard et al., 2013). It could lead to more healthcare complication in events of pandemics such as virulent influenza. Research estimated that low income households live in overcrowded conditions, where more than 70,000 housing units in USA are overcrowded (Potter, Trussell, & Moreau, 2009). The issue is more complicated with most people facing foreclosures which is associated with the downturn of the economy. This accelerates the risk of sharing housing, and doubling up of people with their families and friends (Cai & McAdam-Marx, 2013).
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Academic achievement is strongly correlated with increased lifespan. Generally, people with less education are associated with more chronic complications and their life expectancies are shorter as compared with people with higher level of education (Blanchard et al., 2013). This is indicated by the healthcare study, where adults who have finished high school are more likely to have better health outcomes as compared with dropouts (Salt, 2014). In the USA, the ager adjusted mortality of people who dropped out of high school is two folds higher than those who completed their education.
These people are more likely to suffer from chronic and acute healthcare complications such as hypertension, stroke, diabetes, asthma, ulcers and emphysema. On average, it is estimated that the college graduates live five years longer as compared to those who failed to complete high school education (Diaz de León-Castañeda, RamÃrez-Fernández, & Pinzon Florez, 2013).
Research indicates that education achievement and health are not only correlated at personal level but also in their future generation. For example, maternal education is associated with better health for the children. Similarly, children born by high school dropout’s parents are two folds likely to suffer from premature death. Educated mothers’ infant mortality rates are considerably lower than uneducated parents. This is because educational achievements, wealth and health are interrelated, and have significant impacts on person’s health.
Another important health determinant is social exclusion, which is often associated with poverty. Social exclusion is associated with huge impacts in health such as premature deaths. Absolute poverty results to lack of basic materials, and is still rampant in developed countries (Salt, 2014). Most of the unemployed people, ethnic groups, refugees, homeless and the disabled are often socially excluded. This denies them the opportunity to access decent living opportunities such as education, housing, transport or even the ability to participate in various activities of the lives that makes them participate fully. This exclusion and being treated as lesser beings leads to health complications (Cai & McAdam-Marx, 2013).
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The social exclusions occurs inform of racism, discrimination, hostility, stigmatization as well as unemployment. These denies people their ability to participate in educative training, prevention programs or even accessing potential beneficial healthcare capacities. These issues are socially as well as psychologically damaging, and can have detrimental effects to these discriminated people (Pegram & Bloomfield, 2013).
The longer these people live in prisons, psychiatric facilities and children’s homes, and the more likelihood of them to suffer from a wide range of disorders. These incidences are also associated with increased risk of divorce, addictions and disabilities. Research indicates that people with strong family relations have better health outcomes. For instance, the highest incidences of mental illness are from single parent families (Pegram & Bloomfield, 2013).
Addiction is a public health issue of concern as it is associated with social breakdown, which worsens the issue of healthcare disparities. Addiction in this context refers to overreliance of drug use such as alcohol and cigarrette smoking. This is associated with increased mortality associated with suicides, injuries and poisoning. Although unclear, cultural values and beliefs tend to influence the quality of care (Salt, 2014).
This includes activities such as religious values that prohibits people from seeking medical assistance. Other determinants includes population based healthcare facilities as well as services. These includes activities such as sewerage and water to ensure that people’s health is maintained. The extent of funding of these activities dictates the level of the maintenance of this infrastructure, their developments and also usages.
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Ways the determinants of health impact people’s health
Most of the social factors mentioned above are described to have both interactive and independent effects. For instance, people with high level of incomes are more likely to have achieved higher education. They are also more likely to have more opportunities to live in safe, standard and healthy environments. Their neighbourhoods are more likely to be secure, thus promoting physical activeness. They are also able to purchase organic food as compared to those with low income households. These people are also more likely to have medical cover, which facilitates access to quality care (Cai & McAdam-Marx, 2013).
Conversely, people living with poverty are more likely to have lower education achievement, indicating that they are most likely unemployed. They will often live in substandard housing, putting them at risk of communicable diseases due to overcrowding effects and poor sanitation (Cai & McAdam-Marx, 2013). These people lack enough resources to purchase quality foods, hence depends mainly with fast food, increasing the risk of obesity. These people are more likely to engage in risky behaviours such as drug abuse and prostitutions, putting them at greater risk. This makes them experience higher levels of stress as compared with their counterparts (Pegram & Bloomfield, 2013).
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Whereas most of these factors are interconnected as described above, there is growing evidence that these factors independently determine the health of the people. For instance, in the USA, the health status of all ethnic communities decreases as income level decreases. It is reported that people with 100% federal poverty guidelines (FPG) reports the worse health as compared to people in other income level (Pegram & Bloomfield, 2013). However, within each income levels, specific communities have worse health outcome as compared with others.
For instance, the African American normally reports poor healthcare outcomes as compares to the Hispanics and non-Hispanics white (Cai & McAdam-Marx, 2013). These marked differences across the ethnic communities are observed in other determinants of health. Therefore, to effectively reduce the increased healthcare disparities, issues such as accessibility of educations, standard housing, safe living as well as working environments, healthcare facilities and all other opportunities that facilitate the healthy living of the community must be addressed (Diaz de León-Castañeda, RamÃrez-Fernández, & Pinzon Florez, 2013).
Conclusion
As indicated, it is evident that there is strong correlation between the health and people’s incomes and way of life including community environment, educational achievement, and ethnicity and housing conditions. It is indicated that those people with higher incomes, higher education achievement and those living in a health as well as safe environments have been associated with longer life expectancies and are associated with better health outcomes. Conversely, people with lower education levels, living below poverty line, substandard housing and those in poor neighbourhoods have poor health outcomes. This is attributable to the fact that these lack sufficient resources to treat even the preventable diseases. This translates to increased health disparities among the various ethnic groups.
References
Blanchard, C., Gibbs, M., Narle, G., & Brookes, C. (2013). Learning from communities in the USA and England to promote equity and address the social determinants of health. Global Health Promotion, 20(4 Suppl), 104-112. http://dx.doi.org/10.1177/1757975913501006
Cai, B., & McAdam-Marx, C. (2013). The determinants of antihypertensive use and expenditure in patients with hypertension in the USA. Journal Of Pharmaceutical Health Services Research, 5(1), 11-18. http://dx.doi.org/10.1111/jphs.12041
Diaz de León-Castañeda, C., RamÃrez-Fernández, D., & Pinzon Florez, C. (2013). Compared Analysis of Inequalities in Health and Influence of Social Determinants of Health in Cuba and USA. Value In Health, 16(7), A711. http://dx.doi.org/10.1016/j.jval.2013.08.2189
Fane, J., & Ward, P. (2014). How can we increase children’s understanding of the social determinants of health? Why charitable drives in schools reinforce individualism, responsibilisation and inequity. Critical Public Health, 1-9. http://dx.doi.org/10.1080/09581596.2014.935703
Pegram, A., & Bloomfield, J. (2013). The importance of measuring blood pressure in mental health care. Mental Health Practice, 16(6), 33-36. http://dx.doi.org/10.7748/mhp2013.03.16.6.33.e849
Potter, J., Trussell, J., & Moreau, C. (2009). Trends and determinants of reproductive health service use among young women in the USA. Human Reproduction, 24(12), 3010-3018. http://dx.doi.org/10.1093/humrep/dep333
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The impact that pediatric medical devices have on the world of healthcare
Pediatric medical devices are used in treating or diagnosing conditions and illnesses from birth to the age of twenty-one. There is an extensive range of pediatric devices ranging from imaging machines to tongue blades. While a number of products are designed particularly for children, other products are borrowed from adult applications or are made for more general utilization (Samuels-Reid & Blake, 2014).
This paper provides an exhaustive evaluation of the way in which pediatric medical devices in health care have changed over time. The paper also provides an analysis of the extent to which pediatric medical devices have affected the diagnoses in healthcare. Furthermore, this paper provides an assessment of how target markets have changed with pediatric medical devices.
Medical devices essentially include the items which are utilized in diagnosing, curing, mitigating, treating, or preventing a disease. There is an extensive assortment of medical devices ranging from simple tools such as surgical clamps and bandages to complex ones such as pacemakers. Pediatric patients are amongst those a medical device is designed to treat and include persons aged from birth to not more than 21 years (United States Government Accountability Office, 2016).
Designing medical devices for paediatrics could be difficult. This is because children are by and large smaller and more active compared to adults, their functions and body structures change during childhood, and children might actually be long-term users of medical devices which brings new concerns with regard to longevity of device and lasting exposure to implanted materials (Field & Tilson, 2015).
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Pediatric medical devices in healthcare have changed over time
The history of pediatric medical devices in healthcare is fascinating in terms of how advancements have been made over time to address the unmet needs of paediatrics. As more children continued to suffer from illnesses, medical device manufactures started to make pediatric medical devices that are tailored to youngsters and babies. These devices were vital for improving not just health, but also the quality of life for babies and young people (Zimmerman & Strauss, 2010).
From the 1930s through to the 1940s and 50s, adult respiratory intensive care units (ICUs) were set up for the purpose of battling the blight of the polio outbreak with iron lung ventilators. These respiratory intensive care units, out of necessity, also cared for pediatric patients who had the polio disease (Epstein & Brill, 2012).
In their newly created neonatal ICUs, neonatologists developed procedures for environmental and nutritional support for premature toddlers and sick babies along with ventilation methods and monitoring for the treatment of respiratory distress syndrome, which is also commonly called the hyaline membrane disease. It is worth mentioning that the understanding and utilization of the surfactant and continuous positive airway pressure mechanical ventilation improved to a great extent the survival of babies with hyaline membrane disease (Downes, 2013).
In the 1960s, advancements in pediatric congenital heart surgery resulted in a need of developing intensive care units and devices for providing complex postoperative care. This need was accelerated by the introduction of cardiopulmonary bypass for repairing congenital heart lesions. The first pediatric ICU medical devices were developed by Goran Haglund in the year 1955 and utilized in Europe at Children’s Hospital of Gotenburg in the northern European nation of Sweden (Samuels-Reid & Blake, 2014).
In 1967, John Downes opened a pediatric Intensive Care Unit at Children’s Hospital of Philadelphia, which had a few pediatric ICU devices. Over the next 4 decades, hundreds of pediatric Intensive Care Units were established in many community hospitals, children’s hospitals, and academic institutions across Europe and North America. By 1995 for instance, there were about 306 general pediatric intensive care units in America with pediatric medical devices and that number rose to 349 in the year 2001 (Waugh & Granger, 2011).
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John Gibbon at the Jefferson Medical College Hospital in the state of Philadelphia in the year 1953 carried out the world’s first open heart surgical operation on an infant using the total cardiopulmonary bypass machine that he had designed and developed. Prior to that surgery, adolescents and babies who had congenital heart disease were considered inoperable or they were treated with closed heart surgery (Epstin & Brill, 2012).
In 1938 at Children’s Hospital in Boston, Robert Gross carried out the very first ligation of a patent ductus arteriosus in a young child aged 7 and in 1944, he repaired an aortic coarctation. Still in the year 1944, Swedish professionals Nylin and Craafort carried out a repair of an aortic coarctation (Downes, 2013). In the year 1945 at Johns Hopkins Hospital, Vivien Thomas and Alfred Blalock conducted an extracardiac shunt between the ipsilateral pulmonary artery and the subclavian artery in an infant girl aged fifteen months with tetralogy of Fallot (Epstin & Brill, 2012).
These procedures, in addition to the introduction of cardiopulmonary bypass, served to revolutionize the treatment of heart disease in children and in fact stimulated the development of pediatric cardiac ICUs and medical devices, and helped to improve perioperative care. Noninvasive Mechanical Ventilation was initially introduced during the late 1980s for pediatric patients who had nocturnal hypoventilation (Cheifetz, 2013).
Noninvasive Mechanical Ventilation uses a mask placed over the mouth and/or nose or prongs which are inserted into the nares in order to provide positive pressure ventilator assistance. Either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) which produces differing expiratory and inspiratory positive airway pressures might be utilized (Epstin & Brill, 2012).
Noninvasive Mechanical Ventilation is utilized in augmenting impaired respiratory effort in various illnesses and conditions such as congestive heart failure, asthma, neuromuscular disorders, and cystic fibrosis. In treating adolescents and babies who have hypoxemic respiratory failure with Noninvasive Mechanical Ventilation, professionals have found low incidence of intubation and improvement in dyspnea, ventilation, and oxygenation (Cheifetz, 2013).
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The other respiratory-assist, noninvasive pediatric medical device which has become more and more popular lately is the humidified, high-flow gas that is delivered to the infant through a nasal cannula. In essence, 1 unit of the Vapotherm 2000i delivers about 40 L/min of gas flow with over ninety-five percent humidity (Waugh & Granger, 2011). The high humidity serves to increase comfort at the higher levels of gas and prevent nasal mucosal drying.
In principle, the high-flow system generates continuous positive airway pressure. It is worth mentioning that this device – the high-flow nasal cannula – has been utilized in babies who are premature in order to prevent apnea of prematurity and generates the same distending pressures as nasal continuous positive airway pressure. This pediatric medical device became highly popular owing to its anecdotal success as well as comfort because of subjective improvement of respiratory distress and prevention of intubation of teenagers, children and babies who have respiratory difficulties (Sreenan et al., 2011).
Many children and infants who are severely sick require mechanical ventilation and endotracheal intubation for cardiorespiratory failure or postoperative care. The first mechanical ventilation was designed and developed in the year 1910 by Sievers and Lawen. This ventilator provided negative and positive pressure through a piston cylinder. Iron lungs were the next mechanical ventilators. They were negative-pressure, electrically powered body tanks which were utilized widely for polio pediatric patients in the 1920s, 30s, 40s and even 50s (Downes, 2013).
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Modern mechanical ventilators utilize computers in providing various ventilation modes – volume versus pressure –, to synchronize with the ventilator effort of the patient, and to adjust patterns of inspiratory flow in order to improve gas flow distribution. Initially conceptualized in the year 1972, High-Frequency Oscillatory Ventilation (HFOV) is popular in the treatment of refractory to conventional ventilation in children and babies (Lunkenheimer et al., 2011).
This pediatric device basically delivers a tidal volume not more than the dead space volume at a rate of over a hundred-and-fifty breaths every minute and a higher mean airway pressure (Cheifetz, 2013). High-Frequency Oscillatory Ventilation maintains an open lung but avoids large pressure changes and phasic volume, which minimizes the cyclical stretch of the pediatric patient’s lungs and ventilator-induced lung injury.
Researchers have reported that using High-Frequency Oscillatory Ventilation in the first twenty-four hours of mechanical ventilation decreases the mortality by 47 percent compared with its use after twenty-four hours of mechanical ventilation (Fedora et al., 2010). Moreover, using High-Frequency Oscillatory Ventilation has been shown to improve oxygenation and survival by eighty-nine percent in children without increasing the risk of air leaks and pneumothorax. On the whole, the HFOV pediatric medical device has helped to improve mortality in children and babies, although its efficacy has not been proved in premature babies.
Ventricular Assist Devices (VADs) are utilized in pediatric patients with heart failure. Matsuda and Matsumiya (2012) noted that ventricular assist devices are utilized in patients who have cardiomyopathy with heart failure or severe cardiogenic shock as a bridge to recovery or to heart transplantation. These devices are attached surgically to the failing ventricle with an implantable or extracorporeal pneumatic or electric pump which brings about improved blood flow.
In essence, Ventricular Assist Devices allow for improved quality of life and mobility in adolescents and babies who have failed medical management for their heart failure (Goldman et al., 2013).
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Extracorporeal Life Support (ECLS) pediatric medical device was first employed in the year 1976 in children and babies who had postoperative cardiac failure, persistent fetal circulation, massive meconium aspiration and infant respiratory distress syndrome (Bartlett et al., 2010). This device supports a pediatric patient in circumstances in which the respiratory and/or cardiac disease cannot be medically managed through conventional means and ensures sufficient tissue oxygen delivery for supporting end-organ function.
It is notable that Extracorporeal Life Support involves surgical placement of cannulae into a main artery or vein for veno-arterial Extracorporeal Life Support, or only a main vein for veno-venous Extracorporeal Life Support (Bartlett et al., 2010). In children and older babies, Extracorporeal Life Support has been utilized for support during very serious sepsis, Acute Respiratory Distress Syndrome, or cardiac failure because of cardiomyopathy/myocarditis, hemodynamic instability following congenital heart surgery palliations/repairs, and at times as a bridge to heart transplant (Walker, Liddell & Davis, 2014).
The survival rates for Extracorporeal Life Support pediatric medical device for patients who require cardiopulmonary resuscitation is sixty-four percent in youngsters who have cardiac arrest following open-heart surgery and sixty-one percent in newborns without congenital heart disease (Chen et al., 2011).
Pediatric patients are of many different sizes, ranging from over 100 kilograms to less than 1 kilogram. This creates the need for a wide range of bronchoscopes, endotracheal tubes, catheter sizes, in addition to other pediatric medical devices. Pediatric critical care would today not be possible without the development of size-appropriate pediatric medical devices.
Prior to the 1950s, Shann, Duncan and Brandstater (2013) noted that endotracheal tubes were made with the use of rubber or metal material. Introduced during the ‘50s, plastic polyvinyl chloride endotracheal tubes become less rigid at body temperature and they soften. They are also less probable to bring about subglottic stenosis. When smaller-sized uncuffed and cuffed endotracheal tubes were developed and introduced into the marketplace, prolonged intubation of adolescents and babies was actually made possible (Shann, Duncan & Brandstater, 2013).
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Likewise, intravenous access is of great importance for the administration of medicines and fluids to pediatric patients who are severely sick. During the mid-1940s, plastic catheters replaced metal needles which were rigid thereby making long-term intravenous access possible. In the late 1950s, the current flexible, intravenous catheter-around-the-needle pediatric medical device was developed by George Doherty (Zimmerman & Strauss, 2010).
During the ‘60s and ‘70s, percutaneous central venous access developed. It is notable that the launch of pediatric-sized equipment facilitated monitoring of central venous pressures, placement of catheters for parenteral nutrition, as well as placement of pulmonary artery catheters for measuring hemodynamic variables including pulmonary artery pressure, vascular resistance, and cardiac output (Zimmerman & Strauss, 2010).
When designing the pediatric medical devices which could be implanted into the body of a child, the key factors that have been taken into consideration by medical device manufacturers over the years are as follows: (i) how the pediatric medical device would fit the body of the child as he or she grows; (ii) how the pediatric medical device is absorbed by the child’s body; and (iii) the durability of the medical device (Cheifetz, 2013).
When a medical device manufacturer designs a respiratory medical device for adult patients, the manufacturer could focus on the particular physiologic condition of the patient. However, when the manufacturer designs a respiratory device for the youngest infants, the manufacturer has to think holistically. The manufacturer should think about the baby’s entire body since everything is actually interrelated.
In addition, each aspect of an infant’s growing body has been taken into account over the years in developing effective medical devices for this population. When using surgical tape for instance, the fragile skin of the child is of particular importance. Materials utilized in developing these products are made without detrimental toxins and are gentle on the child’s skin (Shann, Duncan & Brandstater, 2013).
On the whole, in the area of pediatric medical devices, a substantial amount of progress has been made over the years. In making this progress, medical device manufacturers have ensured that they develop products which are tailored to accommodate the lifestyle, activities and growth of a child. Chen et al. (2011) reported that long-term pediatric medical devices are today designed to fit within the lifestyle of children as much as possible and not forcing the children to fit to the medical devices as it used to be the case in the first half of the 20th century when children were forced to fit into medical equipment for adult patients.
Even with chronic diseases, children should be allowed to be children. Over the years, professionals have exploited the opportunity for growth and development in pediatric biomedical engineering as they do their best to create innovative medical devices which improve the quality of pediatric care for children and babies.
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Pediatric medical devices have affected the diagnoses in healthcare
The pediatric medical industry is a very fragmented industry that comprises giant corporations and start-up companies. The Food and Drug Administration regulates many different diagnostic medical devices under specified procedures. It is notable that diagnostic medical devices for pediatric patients range from items such as cardiac monitors, vision evaluation instruments, and blood pressure cuffs to complex imaging equipment.
Basing upon their complicatedness, pediatric diagnostic medical devices are usually assigned to one of 3 classifications – Class I, Class II and Class III – and regulated by the Food and Drug Administration accordingly (Food and Drug Administration, 2016). In addition, diagnostic medical devices for pediatric patients comprise a diverse range of products commonly referred to as in-vitro diagnostic devices: they are essentially systems, instruments, and reagents used in the diagnosis of illness or other conditions.
The Food and Drug Administration regulates pediatric in-vitro diagnostic medical devices in the United States which are manufactured and sold by medical device manufacturers and other tests which are vital in diagnosing a number of uncommon conditions and illnesses (Food and Drug Administration, 2016).
An oxygen machine helps the pediatric patient to breath and a heart pump helps in bringing blood from the heart of the child to the rest of his or her body. These and other pediatric medical devices have helped to save so many children lives. According to the Food and Drug Administration (2016), pediatric medical devices are crucial in treating sick children and infants who are affected by various diseases, including uncommon illnesses.
Pediatric medical devices are helpful in the prevention of premature death and each year, they greatly improve the quality of life for numerous youngsters and infants. Some medical devices are developed particularly for children and infants and some are developed specifically for patients who are above a particular age. Many times however, healthcare providers modify medical devices meant for adult patients for usage in pediatric patients (Samuels-Reid & Blake, 2014).
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Pediatric medical devices are crucial in treating adolescents and infants who have heart disease. Modern examples include ventricular assist medical devices, atrial septal defect occluders, defibrillators, balloon catheters, pacemakers, prosthetic heart valves, endovascular stents.
Epstein and Brill (2012) stated that together with improvements in medical and surgical practice over the last 2 decades, pediatric medical devices have contributed very much to decreasing the overall burden of mortality and morbidity seen in adolescents and babies who have heart disease. Almond (2013) reported that the majority of cardiac medical devices utilized in adolescents and infants nowadays are utilized off-label in which the risk-benefit of those medical devices has not been characterized properly.
In essence, medical devices designed for pediatric patients face a number of challenges to Food and Drug Administration approval linked largely to ethical considerations of device testing in adolescents and babies, heterogeneity of the patient population, and the small target population. Even though comparatively few cardiovascular medical devices have actually been approved by the Food and Drug Administration for use in children, the number of pediatric medical devices that are successfully being approved by the FDA is on the rise (Food and Drug Administration, 2016).
Many FDA approvals of pediatric medical devices are being given via the Humanitarian Device Exemption pathway, which is in fact designed for uncommon conditions which make it appropriate for medical devices that treat pediatric congenital heart disease.
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One major pediatric medical device used by medical professionals and organizations for diagnosis and which has been very helpful in saving the lives of very many babies and children is the Vertical Expandable Prosthetic Titanium Rib (VEPTR). This pediatric medical device has actually been influential in saving the lives of over 320 young children and babies who would have otherwise died due to the lack of breathe considering that they suffered from thoracic insufficiency syndrome (TIS) – a rather rare disease (Shann, Duncan & Brandstater, 2013).
The VEPTR pediatric medical device is basically curved like a ribcage. Moreover, it has holes which allow the surgeon to expand this pediatric medical device in outpatient surgery each 6 months. This device is implanted in adolescents and babies – who could be as young as six months of age – until skeletal maturity, often 16 years in boys and 14 years in girls.
VEPTR was invented by Dr. Robert Campbell and it actually took him thirteen years to obtain approval from the federal drug administration given that it took a very long period of time in accumulating many pediatric patients with rare sicknesses. The VEPTR is intended for a number of purposes which include: treating scoliosis, which refers to a sideways curve within the spine; stabilizing the ribs and spine in adolescents and infants who have serious chest wall deformities to allow these children to breathe better; reconstructing the chest when a number of ribs need to be taken out for some kinds of cancer surgical operation (United States Government Accountability Office, 2011).
On the whole, VEPTR is used in treating adolescents and babies with a group of conditions commonly referred to as thoracic insufficiency syndrome. In this thoracic insufficiency syndrome, the thorax of the pediatric patient – which consists of breastbone, rib cage and spine – are not able to support normal breathing. One of the treatment options entails the placement of a titanium rib. A number of other medical devices have been developed or are currently being developed for use in the diagnosis of pediatric patients in healthcare. Some of these pediatric medical devices are illustrated in the table below (United States Government Accountability Office, 2011):
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Pediatric Medical Device
Condition diagnosed, treated or use
1
Biodegradable valve ring for infants and adolescents
Utilized for repairing cardiac valve
2
PediVAS pediatric circulatory assist device
Utilized in temporary and acute life support for small children and babies
3
Septal cincher
Utilized in reducing the gap of a cardiac valve
4
Pediatric ultrasound imaging for surgical planning and diagnostics
Utilized to perform cardiac imaging
5
Antiseptic and nonthrombogenic catheters for babies
Utilized in treating infection and clotting problems with catheters in infants
6
Bowel lengthening device
Utilized for treating the short bowel syndrome
7
Catheter for peripheral nerve blocks
Utilized for securing catheter placement during pediatric pain management
8
Neurosurgical articulated tools
Utilized during pediatric brain surgical procedure
9
Pyloromyotomy surgical tool
Utilized to make laparoscopic pyloromyotomy easier and safer
10
NICU dashboard
Utilized for monitoring and synthesizing multiple pediatric vital sign inputs
11
Esophageal atresia surgical tool
Used to treat esophageal atresia
12
RoboImplant for scoliosis: a bionic ortho implant that is remotely operated
Used to treat acquired and congenital spine disorders for instance early onset scoliosis
13
Magnetic Mini-Mover for pectus excavatum
Used to treat sunken chest or pectus excavatum.
14
Melody Transcatheter Pulmonary Valve
Utilized in repairing a leaky or blocked pulmonary heart valve which has formerly been replaced to rectify heart defects. This pediatric medical device is inserted without the use of open heart surgical operation and while the child’s heart is beating. It could delay the need for more invasive open heart surgical operation.
15
Debakey VAD Child left ventricular assist system
Used for pediatric heart transplantation. Also used for youngsters aged five to sixteen with BSA 1.5 to 0.7 with class 4 heart failure refractory to medical therapy
16
Shelhigh Pulmonic Valve Conduit Model NR-4000
Used in infants and youngsters aged from 0 to four years who require replacement of an absent or dysfunctional artery
17
Contegra Pulmonary Valve Conduit
Used in youngsters below the age of eighteen years who require reconstruction of RVOT because of pulmonary stenosis, Pulmonary Atresia, and Truncus Arteriosus.
18
Berlin Heart EXCOR pediatric ventricular assist device
Used in youngsters aged sixteen years and below who have class 4 cardiac failure and listed for transplantation
19
CardioSEAL Septal Occlusion System
Used to treat adult and pediatric patients who have complex single ventricle physiology
Target markets have changed with pediatric medical devices
Target markets have changed considerably since medical device manufacturers now have to focus also on pediatric medical devices to satisfy the unmet needs and not focus solely on medical devices for the adult patient population. Even so, the development of pediatric medical devices lags five to ten years behind the development of medical devices for adult patients (Food and Drug Administration, 2016).
As is true for manufacturers of biologics and medicines, medical device manufacturers naturally look for business opportunities in markets of adequate profitability and size in order to merit the investment risk. In particular, if the Food and Drug Administration demands far-reaching clinical data for approval of the medical device, manufacturers might be discouraged from making medical devices for small markets such as pediatric patients by the practical and expense challenges of carrying out satisfactory trials to show efficacy and safety of the device.
Even so, the Safe Medical Devices Act 1990 allowed the Humanitarian Device Exemption (HDE) to promote both the development and introduction of sophisticated medical device technologies to satisfy the unmet needs of small patient populations including adolescents, neonates and infants (Food and Drug Administration, 2016).
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A Humanitarian Device Exemption application contains a sufficient amount of information for the Food and Drug Administration to establish that the medical device does not create a significant or unreasonable risk of injury or sickness, and that the likely benefit to health of the targeted patient population really outweighs the risk of disease or injury from its utilization.
To qualify for a Humanitarian Device Exemption, medical device manufacturers should initially request that the medical device must be designated as a Humanitarian Use Device by the Office of Orphan Products Development. A Humanitarian Use Device refers to a medical device that is designed to benefit patients in diagnosing or treating a condition or illness which is manifested in or affects less than four-thousand people annually in America (Fedora et al., 2010).
If a medical device is to be utilized for diagnosis of diseases, the documentation in a Humanitarian Device Exemption application should show that less than four-thousand patients annually would be subjected to diagnosis by that particular medical device in America.
The Humanitarian Device Exemption provides various incentives for start-ups to manufacture pediatric medical devices which have enabled a number of companies to focus on the pediatric patient target market. For instance, unlike companies that make other products such as drugs and biologics, pediatric device makers are not required to provide clinical evidence that demonstrates the efficacy or effectiveness of their devices (Food and Drug Administration, 2016).
This is a major incentive that has allowed device makers and start-ups to focus on the pediatric patient target market since clinical trials to support efficacy claims often take a number of years to carry out and are costly. Furthermore, the period of time specified for regulatory review of an application is often shorter for Humanitarian Device Exemptions compared to the time period for other premarket approval applications.
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The other incentive for pediatric device manufacturers is certainly the waiver of filing fees often demanded as per the Medical Device User Act, which is more than $200,000 (Food and Drug Administration, 2016). Partly because of these incentives, entrepreneurs at a number of small start-up firms are now developing several ground-breaking and inventive medical devices, focusing on the target market that comprises children aged <21 and these device makers and start-ups seek to address the unmet needs of small patient populations particularly pediatric patients.
Certainly, medical device makers have changed the focus of their target market somehow, from focusing on medical devices for the adult patients to making devices for adolescents, infants and neonates to take advantage of the HDE incentives.
Today, manufacturers of pediatric medical devices are largely entrepreneurs at small, start-up firms. These start-up firms design and produce a number of revolutionary medical devices including medical devices which address the medical needs of small population of patients. Field and Tilson (2015) reported that there are a number of motivations for companies to make pediatric medical devices for small patient populations.
Some start-up firms focus on addressing unmet needs in the society and contribute to the society without the need to navigate the processes of decision-making common with complex, big medical device manufacturers. In other cases, the projected business opportunity is extremely risky or extremely small to be worth attention from current large companies though is still lucrative enough to attract small groups of entrepreneurs or venture capitalists.
It is notable that in exchange for partial ownership of the start-up firm, most venture capitalists and angel investors usually offer the required funding aimed at bringing promising and ground-breaking innovations into the marketplace (Goldman et al., 2013). Besides infusions of capital, venture capitalists and angel investors who have previously worked with other new firms might offer strategic advice and management expertise to guide managers of start-up medical device companies.
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In healthcare, technological innovations could save lives of patients and even increase the quality of life. Artificial hips and knees allow patients to be able to get back to their feet, stents prop open weak arteries, and pacemakers help in restoring rhythm to the patient’s heart. Nonetheless, these medical devices have largely been meant only for adult patients, not children.
For a lot of years, Downes (2013) reported that pediatric patients have been dealing with ill-fitting medical devices which were designed for adults. Healthcare providers were forced to adapt medical devices made for adults to adolescents and babies and the resultant improvisations have usually been far from ideal, not just in terms of safety, but also in terms of efficacy.
However, over the past few years, target markets have changed with more professionals and medical device makers being more willing to produce devices that are particularly customized for infants and children. More and more focus is now being put on the designing and making of appropriate state-of-the-art pediatric medical devices. For instance, the consortium Southern California Centre for Technology and Innovation in Pediatrics (CTIP) was formed in the year 2011 for the purpose of bringing together the best experts to accelerate the development of pediatric medical equipment – a path, which, as Almond (2013) pointed out, has not been lucrative or simple to tread.
In essence, these experts give advice to aspiring developers of medical devices on the process of manufacturing, protection of intellectual property, funding opportunities, regulatory oversight, commercial partnerships, as well as clinical trial design. The CTIP is basically a consortium between Children’s Hospital Los Angeles and the University of Southern California (Children’s Hospital Los Angeles, 2016). It is of major importance to have best advisers given that there are a number of intrinsic challenges in commercializing medical equipment and devices for paediatrics – a field which is typified by usually vulnerable and small patient populations.
There are also a number of contests organized in order to foster innovation which would advance pediatric healthcare and address the unmet medical and surgical device needs for babies and adolescents. For example, there is the yearly contest held by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System in Washington, DC (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
This contest is part of the institute’s 3rd yearly symposium and from 8 finalists, 2 pediatric medical innovators, Prospiria from Texas and AventaMed from Ireland were selected to get a fifty-thousand dollar award. Acknowledging that pediatric ear tube surgical operation is the main reason that youngsters and babies undergo surgical procedure which necessitates general anesthesia, AventaMed designed and created a hand-held ear tube pediatric medical device which does not necessitate full general anesthesia.
On the other hand, Prospiria presented to the contest a non-invasive pediatric medical device utilizing optoacoustic imaging for monitoring endotracheal tube positioning for pediatric life support patients (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
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Conclusion
To sum up, pediatric medical devices consist of the items which are employed in diagnosing, curing, mitigating, treating, or preventing a disease in adolescents, babies and neonates. In healthcare, the history of pediatric medical devices is quite exciting in terms of how progress has been made over the years aimed at addressing the unmet needs of paediatric populations. As more youngsters and infants continued to suffer from various ailments, medical device makers began developing medical devices specifically designed for pediatric patients.
Today, these pediatric medical devices are crucial for improving both the health as well as the quality of life for youngsters comprising adolescents, infants and neonates/newborns. Pediatric medical devices are critical in diagnosing and treating ailing adolescents and babies who are affected by many ailments, including rare ailments. These devices are useful in the prevention of premature death in children.
References
Almond, C. S. (2013). The FDA review process for cardiac medical devices in children: A review for the clinician. Prog Pediatr Cardiol, 33(2): 105-109
Bartlett, R. H., Gazzaniga, A. B., Jefferies, M. R., Huxtable, R. F., Haiduc, N. J., & Fong, S. W. (2010). Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 22:80–93
Cheifetz, I. M. (2013). Invasive and noninvasive pediatric mechanical ventilation. Respir Care48:442–458
Chen, Y. S., Chao, A., Yu, H. Y., Ko, W. J., Wu, I. H., Chen, R. J., Huang, S. C., Lin, F. Y., & Wang, S. S. (2011). Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol 41:197–203
Children’s Hospital Los Angeles. (2016). A better fit: State-of-the-art medical devices are finally being customized for pediatric patients. Retrieved from http://www.chla.org/publication/better-fit
Downes, J. J. (2013). The historical evolution, current status, and prospective development of pediatric critical care. Crit Care Clin 8:1–22
Epstein, D., & Brill, J. E. (2012). A history of pediatric critical care medicine. Pediatric Research, 23(58): 987-996
Fedora, M., Klimovic, M., Seda, M., Dominik, P., & Nekvasil, R. (2010). Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome. Bratisl Lek Listy 101:8–13
Field, M., & Tilson, H. (2015). Safe Medical Devices for Children Executive Summary. Institute Of Medicine.
Goldman, A. P., Cassidy, J., de Leval, M., Haynes, S., Brown, K., Whitmore, P., Cohen, G., Tsang, V., Elliott, M., Davison, A., Hamilton, L., Bolton, D., Wray, J., Hasan, A., Radley-Smith, R., Macrae, D., & Smith, J. (2013). The waiting game: bridging to paediatric heart transplantation. Lancet 362:1967–1970
Lunkenheimer, P. P., Rafflenbeul, W., Keller, H., Frank, I., Dickhut, H. H., & Fuhrmann, C. (2011). Application of transtracheal pressure oscillations as a modification of “diffusing respiration”. Br J Anaesth 44:627
Matsuda, H., & Matsumiya, G. (2012). Current status of left ventricular assist devices: the role in bridge to heart transplantation and future perspectives. J Artif Organs 6:157–161.
Samuels-Reid, J. H., & Blake, E. D. (2014). Pediatric medical needs: A look at significant US legislation to address unmet needs. Expert Rev Med Devices, 11(2): 169-174
Shann, F. A., Duncan, A. W., & Brandstater, B. (2013). Prolonged per-laryngeal endotracheal intubation in children: 40 years on. Anaesth Intensive Care 31:663–666
Sheikh Zayed Institute for Pediatric Surgical Innovation. (2016). 2015 Highlights: 2015 Sheikh Zayed Prize for Pediatric Device Innovation. Retrieved from http://www.pediatric-surgery-symposium.org/
Sreenan, C., Lemke, R. P., Hudson-Mason, A., & Osiovich, H. (2011). High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 107:1081–1083
United States Government Accountability Office. (2011). Pediatric medical devices: Provisions support development, but better data needed for required reporting. GAO
Walker, G., Liddell, M., & Davis, C. (2014). Extracorporeal life support—state of the art. Paediatr Respir Rev 4:147–152
Waugh, J. B & Granger, W. M. (2011). An evaluation of 2 new devices for nasal high-flow gas therapy. Respir Care 49:902–906
Zimmerman, J. J., & Strauss, R. H. (2010). History and current application of intravenous therapy in children. Pediatr Emerg Care 5:120–127
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Breast Cancer Screening
Why is breast self-examination being replaced in the breast cancer screening guidelines by mammography and breast magnetic resonance imaging?
Breast cancer screening is normally done to facilitate early detection. This is important as it saves millions of lives in the world. According to guidelines by the American Cancer Society, breast screening should be done regularly. One of the most common and most easy methods is breast self-exam (BSE). This method has been advocated for in the recent past as it enables the women have sense of control over their breasts. Research highlights that over 70% of breast cancers incidences have been reported via BSE screening technique (Mahon, 2012).
However, there have been critiques on BSE screening method; especially due to increased incidences of benign biopsy. This is attributable to low specificity and sensitivity values. The excessive biopsies are associated with risk of cancer, emotional stress and disfiguring of the breast. The guidelines also tend to favour breast magnetic resonance imaging as well as mammography over breast self-exam method of breast screening. Magnetic resonance and mammography breast screening methods have high level of specify and sensitivity (Morrow, Waters, & Morris, 2011).
What are the risks associated with breast cancer screening? Do the risks outweigh the benefits? Why or why not?
Breast screening is important, especially for the woman in the case study as she is at high risk age. Breast screening involves process that aid in detecting breast cancer at early stage. Breast screening is done using many methods including mammogram, breast self-exam, and magnetic resonance imaging among others. Breast screening saves lives by ensuring that cancer is detected early, and appropriate interventions are made on a timely manner (Morrow, Waters, & Morris, 2011).
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However, there are risks involved in breast screening. To begin with, it is vital for a patient to understand that breast screenings does not prevent cancer. Some of the processes are uncomfortable and is associated with mild pain. Additionally, some processes involve use of X-rays- indicating that patients are exposed to radiation, which could lead to side effects.
However, the benefits outweigh the risks; therefore, every woman should be encouraged to undergo breast screening. There are many things that cause changes in the breast tissue. Although some of them could be harmless, it if important to get breasts checked as there is a small chance that the changes ignored are first indicator of cancer (Mahon, 2012).
References
Mahon, S. (2012). Screening for breast cancer: Evidence and recommendations. Clinical Journal of Oncology Nursing, 16 (6), 567-571. doi10.1188/12.CJON.567-571
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The Department of Emergency
Question 24
The Department of Emergency has the role of providing emergency services that are comprehensive to all patients 24 hours in 7 days of a week throughout the year. In particular, it offers patient care services including:
Accepting every patient who comes with acute illness and provide treatment for them.
Accepting 5-level triage patients as stipulated in the Canadian Triage Acuity Scale System (CTAS); and ensure assessment and sorting of patients is done according to acuity.
Performing emergent resuscitation and medical intervention.
Planning for the assessing, diagnosis, treatment as well as referrals for specialized medical treatment for all patients when necessary.
Providing advanced Trauma Care for patients with trauma.
Liaising with all other departments in the hospital for admission of patients and follow-up.
Providing care when a disaster occurs within the community by operating an Urgent Care Centre in a manner that is almost continuous to ensure needs of patients’ presentations that are less acute are met as well as receiving and assessing the stability of direct admissions, which includes Medivac patients on their way to critical or specialized care units within the hospital.
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Emergency and admission procedures for both new and existing patients have been laid down for any medical, psychiatric and surgical emergency, for the initiation of life-saving care procedures in a timely manner. In particular, for all emergency situations the basic procedures for both new and existing patients begins with diagnosis, initiation of treatment, discharge in case of recovery, admission for treatment continuation or monitoring, appropriate referral for specialized care in case of complications, and then follow up services.
The department of emergency medicine uses an electronic information system for the purpose of recording patients’ details when available or await for them afterwards, and transfers them to the relevant intensive care units for surgical and acute medical emergencies since they these services are only offered for a short time in the department prior to the transfer of the patients to appropriate in-patient units.
The system’s main users are the emergency department personnel, and its easy access and security is guaranteed due to its location in the King Khalid University Hospital (KKUH) Building’s ground floor, near the building’s main entrance.
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Migraine
Migraine occurs at all ages, but it is most common in the 3rd -5th decades of life. The prevalence rates are higher between 20-55 years, and peaks at age 40. Migraine is inherited. Most people suffering from migraines usually have family members that have them too. Research indicates that if one of parents suffers from migraines, there is a 50% chance that the child will suffer from migraines. If both patients suffer, the probability that the child will suffer from migraines increases to 75% (Bolay and Ertas, 2012).
The discussion explored the various types of headaches including rebound headaches and tension type of headache. The emerging theme from this discussion is the need to conduct complete history and physical assessments to rule out other causes of headaches. This includes the use of CT and EEG, their importance during diagnosis and monitoring disease progression.
However, these diagnostic tests should be conducted only if health assessments dictate so. It has been reported that headaches with aura increases a person’s risk factor for stroke. Therefore, it is important to assess patient risk to ischemic stroke, especially on women under hormonal replacement therapy and birth control tablets (Lampl et al., 2014).
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Most contributions on triggers have been mentioned. This includes fasting, stress, worry, menstrual periods, fatigue, head trauma, birth control pills, physical inactiveness, lack of sleep, hunger, and certain foods or drinks especially those that contain nitrites, tyramine, glutamate, and aspartate. Certain medications and chemicals substances have been found to trigger headaches, including estrogens, perfumes, nitroglycerin, hydralazine, and organic solvents with a strong (Rana et al., 2014).
The issue on treatment was also discussed. The main preventive strategies are lifestyle modification. NSAIDs such as ibuprofen, naproxen, and diclofenac are more effective as compared to aspirin or paracetamol. However, Triptans and Excedrin are more efficient for treating acute head attacks. Propranolol can also be prescribed if no contraindications are noted. Botox medications are effective for treating chronic migraines; usually used when all other treatment regimen is unsuccessful (Jackson, Kuriyama, & Hayashino, 2012).
Lampl, C., Jensen, R., Martelletti, P., & Mitsikostas, D. (2014). Refractory headache: One term does not cover all – A statement of the european headache federation. The Journal of Headache and Pain, 15(1), 1-2. doi:10.1186/1129-2377-15-50
Jackson, J. L., Kuriyama, A., & Hayashino, Y. (2012). Botulinum Toxin A for Prophylactic Treatment of Migraine and Tension Headaches in Adults. The Jouranl of American Medicine, 307(16), 1736-1745. doi:10.1001/jama.2012.505.
Rana, A. Q., Saeed, U., Khan, O. A., Qureshi, A. R. M., & Paul, D. (2014). Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma. Journal of Neurosciences in Rural Practice, 5(4), 409-411. doi:10.4103/0976-3147.140005
Donnet, A., Daniel, C., Milandre, L., Berbis, J., & Auquier, P. (2012). Migraine with aura in patients over 50 years of age: The marseille’s registry. Journal of Neurology, 259(9), 1868-73. doi:http://dx.doi.org/10.1007/s00415-012-6423-8
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Side effects of using corticosteroid to treat Addison’s disease
Patients diagnosed with Addison’s disease needs to take up their medication daily in order to replace the inadequate hormones. This normally helps the patients to live a normal life. Treatment mainly involves use of corticosteroids (steroid therapy) to replace hormones lost and those not produced by the aldosterone. Although these medications are effective, corticosteroids are associated with short term and long term side effects (Bentley, 2011)
The short-term side effects includes stomach upset, increased irritability, weight gain due to water retention, increased fat on the face, unusual hair growth , high blood pressure, and risk of other infections. The long-term side effects include muscle weakness, brittle bones, and stunted growth among the children. To minimize such side effects, people taking the drugs should be watched carefully and of necessary, their doses reduced as low doses can be effective and have minimal side effects (In Arieti, 2014).
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Factors that make it problematic for management Addison’s disease in adolescents
The process of diagnosing Adrenal insufficiency is usually a challenge. This is because most of clinical manifestation are nonspecific, and tend to vary according to the underlying causative agent and extent of disease progress. It is important to make early diagnosis as the disease can be life threatening if not diagnosed early enough. The signs and symptoms and management of the diseases are the main challenges faced by the adolescents diagnosed with Addison’s disease. These include issues such as fatigue, malaise, and general muscle weakness. This negatively impacts on quality of life and their daily activities (Helms, 2015).
Importance of inter-professional team for treatment of Addison disease
Team-work in management of Addison disease is important as it aids in improving patient quality of life, reduce mortality, improve communication, reduce errors, and increase patient satisfaction. In this case study, healthcare staff from the following disciplines should work together when delivering care to Addison’s patients. These include physicians, nurses, nutritionists, pharmacists, and physiotherapists. This will help in developing a detailed case related information, which facilitates the decision making processes (Bar, 2013).
