Bloom Taxonomy Essay Paper

Bloom Taxonomy
Bloom Taxonomy

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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.

Helmreich. R.L & Schaefer H.G. (2009). Team performance in the operating room and Human error in medicine. Hillside, NJ: Lawrence Erlbaum.

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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Improving Obstetric Patient Outcomes

Improving Obstetric Patient Outcomes
Improving Obstetric Patient Outcomes

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Improving Obstetric Patient Outcomes

Labour complications are the leading cause of long term disabilities, mortalities and morbidity for both the mother and the babies. One of the approaches is to assess the patient obstetrical history to identify if the pregnancy is a high risk or not. Certain maternal risk factors are associated with risk factors and are identified by assess the outcomes of previous pregnancies.

In this context, the patient had suffered from spontaneous abortion during her first pregnancy. This is the main factor that could be associated with the prolonged labour and increased bleeding post-delivery. The excessive may result due to the opened blood vessels during the caesarean delivery (Pillitteri, 2014).

 To save the lives of both the child and the mother, it is important to identify emergencies in the obstetric settings early enough.  This is because emergencies can lead to the permanent disabilities or even death of the mother, the infant or both. The main approaches identified by the evidence based practice that can be utilized includes, drills, protocols, simulation and vital sign alerts.

Improving Obstetric Patient Outcomes

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In this case study, the best approach that should be used is the protocols. The most strategic approach in this case is use of protocols. Protocols refer to set of rules and procedures that must be followed based on the conventions that have been proven to work in such incidences  (Kee, Hayes, & McCuistion, 2015).

The main advantage is that it helps the healthcare provider make the most ethical decision as required by the organization and their professional standards. Secondly, because the  information in the protocols are written according to the evidence based research, it provides the most effective remedy to patients irrespective  of where or who delivers the care i.e. makes quality care the standard.

The main challenge is the possibility of err in healthcare protocols, because the judgement value made by guideline could be the wrong choice for this particular patient. Secondly, effective use of protocols is determined by the nurse experience and clinical opinions, and thus, for an inexperienced nurse can pick the most inferior options due to misconceptions or misrepresented community norms (Hinkle & Cheever, 2013).

Improving Obstetric Patient Outcomes

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In this context, the protocol of postpartum assessment includes the assessment of patient’s vital signs, the assessment of breasts, bladder, fundus, perineum, lochia, legs as well as any other incision in the body. The patient pain must be assessed including the location, the type of pain, quality and degree of severity. If necessary, pain medications can be administered to reduce the irritation as well as the swelling. From the assessment records, the postpartum condition of the patient was normal. However after one hour, the patient calls for help, as she feels that she is bleeding a lot (Pillitteri, 2014).

The nurse assessment notices the vaginal bleeding, the patient if diaphoretic, pale and her fundus is boggy even with a firm massage. This is an indicator of postpartum haemorrhage, which could be due to uterine atony and trauma. According to the protocols, the patient should be administered oxytocin IV or IM.

If the intravenous oxytocin is unavailable, or the bleeding still continuous, then the  following medication should be used, including  the intravenous ergometrine, prostaglandin (sublingual misoprostol, 800 µg)  or combination of oxytocin-ergometrine is strongly recommended. The approach will reduce the bleeding rate and improve the patients’ quality of life (Kee, Hayes, & McCuistion, 2015).

References

Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach (8th ed.). Philadelphia, PA: Elsevier.

Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.

Improving Obstetric Patient Outcomes

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Treating Addison’s Disease Essay

Treating Addison's Disease
Treating Addison’s Disease

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Treating Addison’s Disease

 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).

References

Bar, R. S. (2013). Early diagnosis and treatment of endocrine disorders. Totowa, N.J: Humana Press.

Bentley, P. J. (2011). Endocrine pharmacology: Physiological basis and therapeutic applications. Cambridge [England: Cambridge University Press.

Helms, R. A. (2015). Textbook of therapeutics: Drug and disease management. Philadelphia,

Pa: Lippincott Williams & Wilkins.

In Arieti, S. (2014). American handbook of psychiatry. New York: Basic Books.

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Medical Malpractice – Wrong Medication

Medical Malpractice – Wrong Medication
Medical Malpractice – Wrong Medication

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Medical Malpractice – Wrong Medication

Introduction

Medical malpractice in nursing constitute professional negligence which maybe as a result of an act or omission intended, or unintended by a nurse or a care giver where the treatment received falls below the required or accepted standard of nursing practice in medical community and which may result in death or injury to the patient. The most common medical malpractice in nursing is medication errors.

                Approximately 1.3 million patients are injured in the US every year as a result of wrong medication (Conrad & Marks, 2016). Medical Error occurs when preventable events that cause or may lead to wrong or inappropriate medication in the control of a patient’s medical condition.

Medication errors make it mandatory for nurses to follow a defined pattern of administering drugs to patients. Following several incidences of nurses administering wrong medication some hospitals allow nurses to administer certain medical procedures and treatment under the supervision of doctors only (Caron, 2011).

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             The scrutiny of academic qualification documents  and other professional qualification that are required for nursing practice in the US take a longer period to ensure thorough scrutiny of nurses papers and their backgrounds including the institution of training number of years and the experience gained  and the hospitals worked in.

                        The high rate of medication errors has made it very difficult for nurses to serve patients on their own except under supervision in large hospitals.

References

Conrad, M. S. & Marks, J.W. (ed) (2016) The Most Common Medication Errors retried March 21, 2016 from http://www.medicinenet.com/script/main/art.asp?articlekey=55234

The website source from Conrad and Marks (2016) outlines the most common medication errors that are prevalent in the medical spheres. The website defines a wide range of medical malpractices some that originate from the drugs manufacturing companies while others from negligent medical practitioners and care givers including nurses. The source also provides preventive measures that can be applied to reduce medication errors.

Caron, C. (2011) Nurse Gives Patient Paralytic Instead of Antacid, abc news, retrieved March 21, 2016 from http://abcnews.go.com/Health/nurse-patient-paralytic-antacid/story?id=14997244

The article provides the details of medical malpractice concerning a nurse who mistakenly administered a drug to a patient who later died as a result of the drugs complications from and which later turned out to be that are related to other conditions that 

Croke et al (2003) Nurses, Negligence and Malpractice, Uppincott Nursing Center eNews, American Journal of Nursing, AJN, September, Volume: 103, Number (Page 54 -57) retrieved March 21, 2016 from http://www.nursingcenter.com/journalarticle?article_id=423284

The article that first appeared on the American Journal of Nursing details and tracks malpractice in Healthcare Organizations. The article defines malpractice as unethical or improper conduct or unexplained lack of skill among professionals which border on negligence or gross incompetency. The article outlines the different kinds of malpractices that nurses experiences in the normal cause of duty.

Aiken, L.H., Clarke, S.P.,  Sloane, D.M.,  Sochalski, D.M. and Silber, J.H. (2002)Hospital nurse staffing and patient mortality, nurse burn out, and job dissatisfaction. Journal of the American Medical Association 288(16):1987–93.

The article suggests that the high mortality rates that have been recorded in US health Institution are mostly related to understaffing among the nurses, burnouts and job dissatisfaction.

American Association of Critical-Care Nurses (2005) AACN Standards for Establishing and sustaining healthy work environments.www.aacn.org. American Nurses Association Code of Ethics Project Task Force .A New Code of Ethics for Nurses. American Journal of Nursing 100 (7):69–72.

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This article that was published by AACN outlines the ethics that guide nurses in their stations of work. The malpractices are having a negative effect on Americans.

Treadwell, H.M., and M.R. O. (2003) Poverty, race, and the invisible men, American Journal of Public Health 93:705–7.Veatch, R.M.2003. The Basics of Bioethics, Seconded. Upper Saddle River, NJ: Prentice Hall.

The journal describes the challenges faced by the poor and their quests for treatment and the basis for Bioethnics which refers to the treatment of such issues like abortion and euthanasia.

Volbrecht, R.M. (2002) Nursing Ethics: Communities in Dialogue. Upper Saddle River, NJ: Prentice Hall. Weston,

 The book outlines the new nursing standards in the year and compares them to the current changes in medical fraternity including in such areas as bioethical isssues,

Weston, A. (2002) A Practical Companion to Ethics, 2nded. New York: Oxford University Press.

Weston (2002) describes the various practical ways of ensuring that all interdisciplinary ethical standards are all followed and put into practice to the letter.

Mercy, J.A., Krug, E.G.  Dahlberg, L.L. and Zwi. A.B. (2003) Violence and health: The United States in a global perspective, American Journal of Public Health 92:256–61.

The Public health journal traces the sources of violence in health care industry and relates the rate of violence in hospitals as associated with inadequate training, lack of dedication and discipline.

Milio, N. (2002) Where policy hits the pavement: Contemporary issues in Communities, In Policy and Politics in Nursing and Health Care, 4th ed., pp. 659–68.St.Louis, MO: Saunders.

The article describes the difficult situations that the nursing industry has been exposed to and the current challenges facing the situation.

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Side effects of using corticosteroid to treat Addison’s disease

Side effects of using corticosteroid
Side effects of using corticosteroid

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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).

References

Bar, R. S. (2013). Early diagnosis and treatment of endocrine disorders. Totowa, N.J: Humana Press.

Bentley, P. J. (2011). Endocrine pharmacology: Physiological basis and therapeutic applications. Cambridge [England: Cambridge University Press.

Helms, R. A. (2015). Textbook of therapeutics: Drug and disease management. Philadelphia,

Pa: Lippincott Williams & Wilkins.

In Arieti, S. (2014). American handbook of psychiatry. New York: Basic Books.

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Type 1 Diabetes Diagnosis Essay Paper

Type 1 Diabetes
Type 1 Diabetes

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Type 1 Diabetes

Being newly diagnosed with diabetes can be overwhelming and confusing due to the several things that a patient needs to learn and understand. However, for millions of diabetic patients learning about their diabetes is the first step towards living a longer and healthier life. According to Shaw (2014), Registered Nurses (RNs) play an important role of educating individuals that have just been diagnosed with diabetes encouraging them that they can live longer if they follow important guidelines for managing diabetes.

First, the RN should let the patient understand what type 1 diabetes is and how its symptoms present by highlighting the classic symptoms associated with diabetes such as excessive thirst and hunger, fatigue, unexplained weight loss, nausea, and vomiting. She should encourage the patient that he is not the only one suffering from type 1 diabetes.

Most youth with type 1 diabetes do not adhere to clinical guidelines (Wood et al, 2013). Therefore, the nurse can use examples of patients of almost similar age to the patient and are coping well with diabetes mellitus. The nurses should also explain to the patient that insulin injections are the central treatment for type I diabetes and for the patient to lead a quality life she should adhere to her medication.

For proper management of type I diabetes, some of the factors that the RN should focus on mainly includes control of blood glucose, insulin management, nutrition, exercise, and support (Atkinson, Eisenbarth & Michels, 2014). The nurse should advise the patient to measure his blood glucose levels regularly and administer insulin appropriately. Exercise on the other hand is a significant component of proper care for type I diabetes as it aids the body to respond with more stable levels of blood glucose (Haas et al., 2013).  

However, patients should be cautioned against extreme exercise which lowers their glucose levels considerably. Additionally, the nurse should aid the patient understand how various foods affect blood glucose and enlighten them on how to come up with solid meal plans (Chiang et al., 2014). She should also encourage the patient to seek help from other people with the same condition and be free to visit the medical center in case of any clarification.

The steps of the teaching learning process that were most likely not well employed are the implementation and the evaluation steps. In the implementation step, the nurse should have delivered content in a manner that is more organized with the aid of planned teaching strategies. The evaluation step could be improved if the nurse questioned the patient on some aspects such as why insulin is important in management of type I diabetes and more so the rationale of giving it as an injection instead of pills.

References

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetesThe Lancet383(9911), 69-82.

Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care37(7), 2034-2054.

Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & McLaughlin, S. (2013). National standards for diabetes self-management education and support. Diabetes care36(Supplement 1), S100-S108.

Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., … & Williams, J. W. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Annals of internal medicine161(2), 113-121.

Wood, J. R., Miller, K. M., Maahs, D. M., Beck, R. W., DiMeglio, L. A., Libman, I. M., … & T1D Exchange Clinic Network. (2013). Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes care36(7), 2035-2037.

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Cholera Outbreak Research Paper

Cholera Outbreak
Cholera Outbreak

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Cholera Outbreak

Introduction

Cholera is a diarrheic condition that is caused by bacteria known as Vibrio cholerae. The bacterium is an enterotoxin that affects the ileum. Patients with this disease present with a sudden onset of rapid watery stool that is painless (Sekar, 2012). Early stages of cholera are manifested by rapid vomiting and nausea. When cholera is not treated, it can results into hypoglycemia in children, circulatory collapse, dehydration, renal failure and acidosis.

The infection is transmitted by asymptomatic carriers. Cholera is mostly asymptomatic or occasionally causes moderate diarrhea particularly with EI T micro-organisms or biotype. Death occurs within a few hours in severely dehydrated cases where by the rate of case-fatality may go beyond the 50% mark. However, timely and effective rehydration reduces the death rate to 1%.

Background                                                                                

A cholera outbreak was first detected in The Central African Republic (CAR) in the early months of 1997 and hit the country for the second time in 1999.

The affected regions within the country included the sub-prefecture of Ngaoundaye. This is located along river Oubangui which is located near the border with Chad(Dworkin, 2010).  Sékia moté village had the very first few reported cases and within a short period, the outbreak had spread to the prefecture of Lobaye and its environs and to the city of Bangui.  Ombella Mpoko district and seven other villages where the Oubangui River passed later became part of the tragedy.

The outbreak was primarily discovered after the chief’s son of Sékia mote village became sick and passed away after showing signs of profuse diarrhea, abdominal pains and fever. The chief of Sékia mote village reported the case to the district’s governor on the very same day it occurred, who then alerted the Ministry of Health immediately later that day.

Both private and public health facilities in the Central African Republic (CAR) recorded extraordinary cases of watery diarrhea from Sékia moté village and several other villages to the Ministry of Health (Kamradt, 2015).

On the 25th of September 2011, a stool sample was obtained from a patient that had been transferred and got admitted at the community clinic in Bangui by two of the laboratory technicians from the Central African Field Epidemiology and Laboratory training Program (CAFELTP)(Nair, 2014).

After three days of thorough testing, the National Laboratory in Bangui (NLB) isolated Vibrio cholera sero group 131 from the earlier submitted specimen of stool with the help of a laboratory expert, from the NCIRD/GID.

This fostered the drive of Global Immunization Division, Immunization Systems, and Centers for Disease Control and prevention (CDC) since they were certainly convinced that the disease was cholera. On September 30th, cholera outbreak was declared officially in CAR. Rapid response team was put in place by the Minister of Health (MOH). The team comprised of CAFELTP residents, WHO, MSF staff, UNICEF, MOH staff, and others. The team established a series of control and preventative guidelines that would curb the spread of the outbreak.

The first measure entailed enhancing treatment capacity and cholera surveillance at the already existing health facilities. Secondly, the city of Bangui and affected villages had to have cholera treatment facilities. Thirdly, endorsing practices such as improved sanitation, proper food preparation, proper funerals and burial. The fourth measure was on affected people were to be advised on usage of oral rehydration solution and encouraged to seek medical attention at the onset of watery diarrhea. Finally, there were to be provision of chlorine for treatment of drinking water.

The rapid response team had a report of the case as by October 23rd. The record indicated that there were a total of 172 individuals who were suffering from acute watery diarrhea and also recorded 16 cholera deaths. This study was carried out with the goal of identifying risk factors associated with cholera outbreak. Moreover it also focused on assessing how prepared the affected districts were in controlling the outbreak.

Cholera Investigation

Environmental investigation

Many households were constructed along river Oubangui. The distance between the river and these households was approximately 20 meters. Generally, there was poor hygiene in the village characterized by mud and stagnant water (Kurjak, 2015). The children in the village were playing and walking bare feet in the mud and at times not fully dressed. Villagers were commonly using pit latrines whose maintenance was poor. Oubangui river was has many uses which include a source of drinking water, fishing, swimming and defecation.

Epidemiological investigation

The Ministry of Health requested CAFELTP resident advisors to assist in investigation and control of cholera outbreak in Central Africa Republic. The CAFELTP officials formed a rapid response team that worked in the affected areas. The team members were assigned different duties. For instance, one of the epidemiological officials was charged with the responsibility of reporting and collecting data on cholera outbreak where as two other lab technicians had the responsibility of collecting and analyzing samples.

Moreover, the advisors of these officials arrived in Bangui after two weeks. Upon arrival, they were taken through the events in Bangui by the CAFELTP staff and the officials from the MOH on the matter at hand and evolution of cholera. A data collection instruments and a protocol were developed by the residents and RAs. The main risk factors were highlighted as follows, lack of infrastructure for sanitation, drinking untreated water, and attending a cholera case funeral. Cholera Treatment Facility in Mbobo and Bangui district held arena for questionnaires pre-testing. In-country procedures such as mission orders, submission of terms of reference were followed before going to the field.

Coincidentally, during the outbreak investigation several campaigns on cholera awareness were underway in different areas of the country. The awareness involved sessions of community education and use of mobile Information Education Communication (IEC) resources presented on posters, TV, radio, cars, and mobile phones prevention messages.

Confirmation of the outbreak

The term outbreak is simply defined as a sudden increase or start of disease of fighting. It can also be defined as a sudden increase in numbers of a harmful organisms particularly the insects within a specific area. A disease outbreak is the occurrence of diseases in excess beyond the normal expectations in a specific geographical area, season or community.

An outbreak may emerge in a restricted geographical area or even spread to several countries. Its duration may be a few days, weeks or several years(Sekar, 2012). Definition of an outbreak enables those responsible for managing an outbreak occurrence to report the condition in its early stages to the responsible authorities.

The director of disease control conducted training sessions on cholera management in the hospitals as well as the community. The training was done to the health personnel in the affected districts.  Weekly review notification records under joint custodian of the (WHO) and MOH, found 172 individuals diagnosed with suspected cholera. In the CAR from September 20th to October 26th, national case fatality rate was 9.3%.

Data on the number of individuals infected with cholera was sourced from the WHO Bangui office, cholera treatment centers and health centers in the affected areas. Medecins Sans Frontiers (MSF) were responsible for collection of the data on infected individuals. These information was used by the investigators in performing a comprehensive analysis of cholera outbreak.

Assessment on the level of epidemic readiness and response was carried out in each district using a checklist. General hygiene in the affected areas termed environmental investigation was also assessed. Stool and water samples were taken to the lab to be examined for Vibrio cholerae.

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Epidemic preparedness and response (surveillance)

None of the visited districts had either an epidemic readiness plan or a committee in place prior to the outbreak. There was provision of IV fluids and protective materials after the event of the outbreak. Some of the health centers such as Kamba had a radio system that was functional for communication, the health centers in Ngazi and Mogo had no means of communication. Unfortunately they had to travel for about 35 Km by bicycle or foot to the health facility (Shah, 2016).

Epidemic management funds were not available in the country before the occurrence of the outbreak. However, there were disinfectants in the entire health district that was visited. Chlorine used for water treatment was distributed by ministry of health to the two villages. Centers for chlorine treatment were planted at Bangui hospital, Ngazi and Mbombo health facilities. At the time of visit, these centers were functional although each had at least one cholera patient.

One personnel in Ngazi and Mongo village managed the public health surveillance system. The system was exempted prior to the occurrence of the epidemic.

Case definition

Case definition entails a standard criterion that categorizes an individual as a case. It includes criteria for person, time, clinical features and place. The criteria should be specific to the outbreak under investigation (Madoraba, 2010).

Place

Most houses were constructed along the Oubangui River. The distance between the river and the houses was less than 20 meters. There was generally poor hygiene in the village (Dale 2013). Mud and stagnant water were everywhere. Children played and walked in the mud bare feet and at times not fully dressed. There was common use of pit latrines; however, the latrines were poorly maintained. The Oubangui River served as a source of drinking water and swimming, fishing and defecation.

Person

Diarrhea: Diarrhea as a result of cholera usually has a milky, pale appearance that resembles water that has been used to rinse rice, hence the name rice-water stool.

Dehydration: dehydration develops within hours after the commencement of the symptoms of cholera. The ranges of dehydration vary from mild to severe depending on the amount of fluid lost. Severe dehydration is characterized by a loss of 10% or more of total body weight.

Nausea and vomiting: occurs during the early phase of cholera. Sometime vomiting may occur for hours.

Other signs and symptoms of cholera include lethargy, irritability, dry mouth, and sunken eyes, dry skin that bounces back slowly after it has been pinched into a fold, extreme thirst, little urine output, irregular heartbeat (arrhythmia) and low blood pressure

The people of Bangui expressed symptoms that are consistent with the case definition of cholera outbreak. The environment in Bangui also had conditions that are likely to predispose people to developing cholera

Cases

Cases are categorized into three types; confirmed, possible and probable cases. Confirmed cases are the laboratory confirmed cases such as the cholera victims who had their stool tested for Vibrio cholerae. However probable cases have characteristics clinical features of the disease but they lack laboratory confirmations (Ramamurthy, 2011). For example, there were residents of Mbaika district who had bloody diarrhea but without laboratory testing. Finally, possible cases are those with some clinical features such as abdominal cramps and diarrhea such as three stools in a 24-hour period.

Cholera is a point source epidemic. It arises due to common sources such as contaminated food or an infected food handler. The period for incubation ranges from a few hours to 5 days after infection. Suspected cholera case was defined as any individual of any age that presented with acute watery diarrhea. The most affected individuals were the women living in villages along Bangui River.

Hypothesis

The cholera outbreak in Mbaika district, Central Africa Republic where 170 patients and 16 cholera deaths reported, were related with risk factors that were food borne.  There is a substantive association between cholera and eating cold cassava leaves. Epidemiological studies from Zambia indicated that the major transmission vehicle of cholera outbreak is contaminated food.

Vibrio cholerae could be inoculated into cooked food during preparation by an asymptomatic but infected person (Howard, 2011). However, the cause of contamination of cassava leaves may vary and the study did not determine its course. This hypothesis is true because earlier studies indicate that soiled kitchen ware can contaminate food and the Vibrio cholerae live for up to 2 days.

Discussion

Cholera outbreak caused many deaths in the region. The death rate rose up to 24.2% in Matuu which is higher than the countrywide rate of 9%. MOH in collaboration with various partners assisted in the management of cholera. The investigation produced important results. The outbreak of cholera in Kamba district, Central African Republic where by more than 170 cases and 16 deaths reported, was as a result of risk factors that were food borne.

The case control investigation associated cholera with consumption cold leaves of cassava. Epidemiological study from Zambia indicated that during an outbreak, the major transmission vehicle of cholera is contaminated food. When food is prepared, Vibrio cholerae could be inoculated by asymptomatic but affected person. The source of contamination varies in cassava leaves. The study did not determine its course. According to previous studies, soiled kitchen ware can contaminate food where the Vibrio cholerae persists for 1-2 days.

There was lack of association between the outbreak and water-related risk factors. Cholera transmission through direct waterborne ways was not very evident in these areas. Other previous investigations have reported that drinking water sold in the streets was responsible for the outbreak of cholera in Latin America.

The study ruled out the link between cholera and drinking contaminated water, poor sanitation and attending burials that are cholera related in the district. Households in the two villages are built along the river which makes the area vulnerable especially during floods. Consumption of untreated water from Oubangui River was not proven risky but it should be avoided.

Delay in the analysis of stool samples should be discouraged. It leads to delayed confirmation of an outbreak as well as delayed implementation measures. According to this case, the delay occurred because the outbreak emanated outside Bangui. On the other hand, Bangui National Laboratory (NLB) did not have a means of transport for collecting stool samples from outside Bangui. It is very vital to have all the appropriate resources during an outbreak. Availability of epidemic readiness plan and a committee present in a district results in effective and timely management of the outbreak.  Public health surveillance system management by only one individual in the entire district may not be effective in handling all the threats in public health.

 Conclusion

The outbreaks of cholera in Central Africa are still ongoing but in a slow rate compared to the past three week. Considerable association between cholera and eating cold cassava leaves was identified. First and seventh regions were the only ones affected by the outbreak (Lewenson, 2013). Women and children living along the Oubangui River were the most affected by the outbreak. Lack of transport of samples to the National Laboratory delayed outbreak confirmation. Effective measures in cholera treatment there were to be implemented include; establishment of cholera treatment center, treatment of drinking water, health education on good food and general hygiene.

Lessons learnt

  • The study provided epidemiological information that leads to cholera. They include consuming untreated water, poor sanitation and attending cholera areas.
  • The major transmission vehicle of cholera is contaminated food.
  • Consumption of water sold in the street can also result into cholera outbreak.
  • Lack of laboratory materials transport and communication causes delay in analysis of an outbreak
  • There is need for a stand by epidemic readiness plan and committee in the district that ensures well-timed management of the outbreak.

Recommendations

  • Health education and social sensitization on habits of eating, community hygiene and personal, sanitation and burial practice.
  • System for public health surveillance should be strengthened by the administration.
  • Encouragement of eating food when still hot.
  • Each region should be supported in development of a functional epidemic readiness plan and response committee and a definite epidemic readiness control plan as soon as possible.
  • Ministry of health in conjunction with that of water should ensure that the communities have access to clean water.
  • Laboratories should have basic resources to avoid delaying in laboratory confirmations.
  • The surveillance system should be able to identify outbreaks and report in time.

Bibliography

SEKAR, R., & MYTHREYEE, M. (2012). Microbiological Investigation of Diarrheal Outbreak in South India Cholera Outbreak – Microbiological Investigation. Saarbrücken, LAP LAMBERT Academic Publishing. http://nbn-resolving.de/urn:nbn:de:101:1-20121026248.

NAIR, G. B., & TAKEDA, Y. (2014). Cholera outbreaks. http://public.eblib.com/choice/publicfullrecord.aspx?p=1783335.  

DWORKIN, M. S. (2010). Outbreak investigations around the world: case studies in infectious disease field epidemiology. Sudbury, Mass, Jones and Bartlett Publishers.

TRUGLIO-LONDRIGAN, M., & LEWENSON, S. (2013). Public health nursing: practicing population-based care. Burlington, Mass, Jones & Bartlett Learning.

KURJAK, ASIM. (2015). Textbook of Perinatal Medicine. Jaypee Brothers Medical Pub.

CARNEIRO, I., & HOWARD, N. (2011). Introduction to epidemiology. Maidenhead, Berkshire, Open University Press. http://public.eblib.com/choice/publicfullrecord.aspx?p=863803.

DALE, J. (2013). Understanding microbes: an introduction to a small world. http://catalogimages.wiley.com/images/db/jimages/9781119978800.jpg.  

SHAH, S. (2016). Pandemic: tracking contagions, from cholera to ebola and beyond.

MADOROBA, E. (2010). Cholera: current African perspectives. New York, Nova Science Publishers.

RAMAMURTHY, T., & BHATTACHARYA, S. K. (2011). Epidemiological and molecular aspects on cholera. New York, Springer.

KAMRADT-SCOTT, A. (2015). Managing global health security: the World Health Organization and disease outbreak control.

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Non-adherence to lifestyle change during pregnancy

Non-adherence to lifestyle change during pregnancy
Non-adherence to lifestyle change during pregnancy

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Non-adherence to lifestyle change during pregnancy

Adoption of the right and recommended lifestyle changes during the pregnancy period is essential for every woman to ensure thy experience an exciting time with minimal problems. Positive changes in lifestyle behaviors during pregnancy has the massive impact both on the patient and the fetus (Pinto et al, 2015). However, there are cases of non-adherences to the recommended changes which lead to negative consequences.

Some of the symptoms caused by the poor adherence to changes include problems in the flow of blood in the blood vessels which make it difficult for efficient circulation in the placenta slowing the growth of the fetus. The consumption of alcohol can cause the fetal alcohol syndrome leading to effects such as cleft palate and defects of legs and the arms on the fetus (Pinto et al, 2015).

Non-adherence also leads to change in the function and development of organs thus can, later on, result in birth defects. Poor eating habits would result in malnutrition of the patient who shows frequent signs of fatigue and be weak in nature also affecting the fetus. Headaches, pains, constipation, breathing or heart problems are also signs and symptoms experienced due to non-adherence to recommendations during pregnancy (Leppanen et al, 2014).

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Non-adherence leads to negative impacts both the patient and the fetus. Abnormal development and birth defects are one of the major impacts on the fetus. The poor circulation of blood can affect the patient’s blood pressure at the same time hindering the supply of nutrients and oxygen to the fetus affecting growth (Zheng et al, 2016). Contraction of the uterus can also happen to cause injuries on the fetus.

The non-adherence also results in chronic diseases among the patient who might suffer from diabetes or heart problems later (Zheng et al, 2016). Abnormal bleeding by the patient during delivery that can cause anemia is experienced as a negative impact due to poor adherence to the recommended changes during pregnancy.

Public health initiatives are required to handle the issue of non- adherence among the pregnant patients. Such initiatives include the provision of efficient education, counseling and creation of awareness of the implications and the necessity of adopting the recommended changes (Leppanen et al, 2014). The management through education would eliminate fears such as side effects of taking drugs and also ensure full adherence by the patients.

Substitute therapy is a treatment plan adopted to reduce the high instance of drug addiction which has negative impacts. Providing the right drugs, encouraging medication and providing patients with supplements for nutrition would help handle the signs and symptoms resulting due to adherence.

References

Leppänen, M., Aittasalo, M., Raitanen, J., Kinnunen, T., Kujala, U., & Luoto, R. (2014). Physical Activity During Pregnancy: Predictors of Change, Perceived Support and Barriers Among Women at Increased Risk of Gestational Diabetes. Maternal & Child Health Journal, 18(9), 2158-2166. doi:10.1007/s10995-014-1464-5

Pinto, T. P., Farias, D. R., Rebelo, F., Lepsch, J., Vaz, J. S., Moreira, J. D., & … Kac, G. (2015). Lower Inter-Partum Interval and Unhealthy Life-Style Factors Are Inversely Associated with n-3 Essential Fatty Acids Changes during Pregnancy: A Prospective Cohort with Brazilian Women. Plos ONE, 10(3), 1-17. doi:10.1371/journal.pone.0121151

Zheng, W., Suzuki, K., Tanaka, T., Kohama, M., Yamagata, Z., & null, n. (2016). Association between Maternal Smoking during Pregnancy and Low Birthweight: Effects by Maternal Age. Plos ONE, 11(1), 1-9. doi:10.1371/journal.pone.0146241

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Chronic Asthma: Pathophysiology

Chronic Asthma
Chronic Asthma

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Chronic Asthma

Maslan & Mims (2014) define asthma as an inflammatory condition of the airway that arises due to hyperactivity to a stimuli causing obstruction of airflow, development of fatal exacerbations, and other respiratory complications. Some of the common allergens that have been citied to trigger asthma include mold spores, grass pollen, and animal dander. Medications such as aspirin, industrial materials such as toluene diisocynate, and indoor air pollution are other common triggers of asthma. Asthma can either be acute or chronic both having significant commonalities and differences.

Pathophysiology of Acute Asthma

Research has reported that exposure to inflammatory allergens triggers reactions in the respiratory system. For instance, Cardinale et al., (2013, March) reports that  the onset of acute asthma involves an increased invasion of neutrophils into the respiratory system as well as tumor necrosis factor (TNF), mast cells, and eosinophils. These inflammatory mediators and cells cause increased secretion of respiratory mucous which in turn obstructs the airways, over-inflation of lungs, thickening of the basement membrane, and destruction of the epithelial membrane.

Narrowing of the airway limits inhalation and exhalation exercises of an individual. Consequently, a mismatch in the ventilation-perfusion ration arises. This means that an increase in deoxygenated blood occurs; an event that is quite fatal especially when quick medical attention is not sought.

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Pathophysiology of Chronic Asthma

Just like acute asthma, chronic asthma develops as a result of inflammation in the respiratory system. The allergens initiate the production of inflammatory mediators such as cytokines, histamines, and leukotrines (Maslan & Mims, 2014). These mediators trigger increased contraction and relaxation of the bronchial smooth muscles. Consequently, bouts of airway constriction develop generating the classic symptom of asthma; wheezing.

The narrowing hinders effective exhalation and inhalation. As a result, hypoxia develops and there is increased levels of carbon dioxide in the blood which affects important organs in the body especially the heart, brain, and the kidneys. A number of changes usually occur in patients suffering from chronic asthma. First, there is an increase in eosinophils in the blood supplying the respiratory system and thickening of the lamina reticularis.

The number of mucous secreting cells also increases as well as the size of the bronchial smooth muscles. If medical attention is not sought urgently, patients start presenting with lactic acidosis, hypercapnia, and an unproportional level in the acid-base level in the body. Moreover, in chronic asthma there is an increased degree of hyperactivity to stimuli and an irreversible loss of lung function due to remodeling of respiratory structures.  Smooth muscle hypertrophy and hyperplasia are also common occurrences.

Risk Factor

According to Tai et al., (2014), age is one of the leading risk factor that has a significant impact on the pathophysiology of both chronic and acute asthma. Unlike adults, children are usually highly susceptible to suffering from both acute and chronic asthma. This is mainly because adults have cells that are more resistant to the inflammatory agents compared to children. Normally, adults who have previously been diagnosed with asthma can tolerate the condition for a number of weeks unlike children who can easily die within a short time after experiencing an asthma attack just as it is reported in the case of Dynasty Reese and Bradley Wilson.

It is for this reason that parents should be highly educated on the symptoms of asthma as well as the approaches they should undertake in the event a child presents with the symptoms. Moreover, parents should be enlightened about the risk factors of asthma and how they can safeguard their children from being exposed to the asthma triggers.

Diagnosis

For effective diagnosis of asthma, physicians begin by determining the chief complaint followed by the history of the presenting illness (HPI). Asthmatic patients usually complain about wheezing, coughing, tachypnea, shortness in breath just as it is reported in the case study of Dynasty Reese and Bradley Wilson. Spirometry has been tipped to be an effective approach in the diagnosis of asthma.

This technique is used in identifying the differential diagnosis by determining the FEVI of a patient. For instance, the test is positive for asthma when the FEV1 increases by about 12% while the FVC increases by about 200mL (Killeen & Skora, 2013). Chest X-rays can also be used in the diagnosis of asthma as well as the patient’s family history.

In management of asthma, patients are first given maintenance medications such as inhaled corticosteroids which include fluticasone and betamethasone. Rescue medications are then prescribed. They include bronchodilators such as salbutamol and levalbuterol. For adults with asthma, the most suitable medications are the anti-inflammatory agents such as inhaled steroids where as in children, oral medications like prednisone are recommended (Alexander et al., 2012).  

References

Alexander, A. G., Barnes, P. J., Chung, K. F., Flower, R. J., Garland, L. G., Goldie, R. G., … & Lulich, K. M. (2012). Pharmacology of asthma (Vol. 98). Springer Science & Business Media.

Cardinale, F., Giordano, P., Chinellato, I., & Tesse, R. (2013, March). Respiratory epithelial imbalances in asthma pathophysiology. In Allergy and Asthma Proceedings (Vol. 34, No. 2, pp. 143-149). OceanSide Publications, Inc.

Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nursing Clinics of North America, 48(1), 11-23.

Maslan, J., & Mims, J. W. (2014). What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngologic Clinics of North America, 47(1), 13-22.

Tai, A., Tran, H., Roberts, M., Clarke, N., Gibson, A. M., Vidmar, S., … & Robertson, C. F. (2014). Outcomes of childhood asthma to the age of 50 years. Journal of Allergy and Clinical Immunology, 133(6), 1572-1578.

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