Nursing (205)


Dental caries is one of the most prominent diseases that affect children and adults worldwide [1]. One of the major effects associated with caries is severe pain in the jaws and can lead to the progression of other dental problems. Promising treatments for this infection include the administration of probiotics into the patient's body system. This creates a need to find the most appropriate ways of dealing with the problem of its effect can be experienced. It is critical to locate the treatment for dental caries so that we can curb some of the adverse effects associated with it. One of the primary reasons we should examine the probiotic strains in the prevention of the dental caries is for us to come up with the appropriate cure for the infection. Caries can cause severe pain thus this disease might affect the daily chores of people unless it is treated/ controlled. Sugars/carbohydrate rich meals are favored by most of the population, which makes individuals more susceptible to caries. Due to the adverse effects associated with dental caries, there is great need to find a way to prevent it before its effects can be seen. Thus, probiotic administration research can be used to help patients control the abundance of Streptococcus mutans, caries causing bacteria, and reduce or halt the progression of dental decay in high-risk patients [2].

Probiotic strains can come in different forms that a person can establish to ensure maximum protection is provided. According to research, the study was undertaken using different probiotic vehicles/ samples of yogurt that contains the Lactobacillus rhamnosus GG that showed the significant reduction in MS. There was the use of lozenges that contained the Lactobacillus brevis CD2 [3] that showed a significant reduction in the number of cariogenic microorganisms. The other probiotic vehicle applied was the use of powders that had the content of Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces cereviasae combined for one powder and the Bacillus coagulans, for the second powder [4]. All the experiments showed the significant response of the probiotic contents towards the cariogenic microorganism, and this outlined the different samples of probiotic application in handling the carrier infection.

The intake of oral probiotic tablets at early childhood has a significant reduction in the number of children with the dental carriers. The intake of the strains should be administered in the required amounts so as to get the probiotic provide the antibacterial fight against the dental carries. Having mentioned that better natural prevention measures are the best, these probiotic strains are associated with their side effects with the major and disturbing issues of affecting the early development of a child [5]. When the tablets are administered and chewed on a daily basis, then they subject the person to fluoride which affects the normal functioning of the teeth. However, the brushing of the tooth with fluoride toothpaste will provide the necessary protection, but this still has its negligible effects though the benefit is outlined with the removal of the plaque and the experiencing of bleeding gums. Therefore, the administration of the probiotic pills should get restrained to the justified levels based on a dose-response relationship and the age of the applicants.

The handling of caries in both children and adults should be given the priority of using the probiotic pills for the disease prevention. Dental Carie's disease is highly associated with the diet that a huge population is taking that is rich in sugar that facilitates the dental decay. The basis then requires that the food manufacturing industries takes the caution on the amount of sugar within the foodstuff. There should be the need for creating awareness to the entire population to reduce the consumption of such food, especially at late times before getting to bed. However, this could mean that the intake of such foodstuff will be low, yet it is the stable food to large populations worldwide. This then provides the essence of early administration of probiotic pills to prevent dental caries before the decay and pain are quite well established. The content of pills should also get regulated so that they provide the maximum protection prior the bacteria developing resistance to the strains.


Dental caries is a dominating disease that people take to realize on their advance levels. The failure to diagnosis the problem earlier has made the problem to advance only that early proper lifestyle saves one from such complications. Probiotic strains have been adopted in providing prevention to dental caries and the pills des well especially when administered as prescribed. Despite the fact, the pills have some effects on the early development of the children the correct intake does not affect them to make them dwarf. The best cycle towards supplementing the use of probiotic pills at the early ages should be the observation of the person lifestyle that should be determined by the content of sugar/ carbohydrate taken. Brushing of the teeth using the fluoride toothpaste provides maximum protection against dental caries.



  1. Selwitz R.H., Ismail A.I., Pitts N.B. Dental caries. Lancet. 2007;369:51–59. doi: 10.1016/S0140-6736(07)60031-2
  2. Cagetti MG, Mastroberardino S, Milia E, Cocco F, Lingström P, Campus G. The Use of Probiotic Strains in Caries Prevention: A Systematic Review. Nutrients. 2013;5(7):2530-2550. doi:10.3390/nu5072530.
  3. Campus G., Cocco F., Carta G., Cagetti M.G., Simark-Mattson C., Strohmenger L., Lingström P. Effect of a daily dose of Lactobacillus brevis CD2 lozenges in high caries risk schoolchildren. Oral Investig. 2013 doi: 10.100.7/s00784-013-09-80-9.
  4. Jindal G., Pandey R.K., Agarwal J., Singh M. A comparative evaluation of probiotics on salivary mutans streptococci counts in Indian children. Arch. Paediatr. Dent. 2011;12:211–215. doi: 10.1007/BF03262809.
  5. Hedayati-Hajikand T, Lundberg U, Eldh C, Twetman S. Effect of probiotic chewing tablets on early childhood caries – a randomized controlled trial. BMC Oral Health. 2015;15:112. doi:10.1186/s12903-015-0096-5.




Thursday, 22 February 2018 12:00

Advance Practice Nurse

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Advance Practice Nurse (APN) Discussion

Mary as an Advanced Practical Nurse (APN) has acquired verification to work as a nurse at any level where her expertise is required for validation as a Registered Nurse (RN). She has quality attributes to use nursing knowledge and skills especially in delivering complex decision making when the patient is in critical conditions. She has all qualities of working as APN through her long period as a practitioner with practical training in diagnosing, management of common medical conditions and treating chronic illnesses ( Her decision in working as an APN will fulfill her passionate desires in providing a broad range of healthcare services. Through her profession, she shall be required to work in collaboration with doctors and other health care experts to deliver quality nursing services to patients. Her main duties shall include

  1. Delivering advanced assessment of patients
  2. Administering therapies to patients with mental problems, depression, and drug addicts
  3. Managing potential and actual health care services within her unit level
  4. Implementing development of evidence-based practical through integrating theoretical and practical analysis to influence the development of nursing, health care units by changing policies at the local level and national level (
  5. Promote and inducing research that leads to discovering off better methodologies, tools, as well as medicines required by patients.

Scope of APN

Mary as an APN professional has a wide scope of competencies that are required to make her fully qualified to perform core clinical activities. She must have the potential to perform complex health assessments and physical examinations on individuals, families, and communities.   She is required to make decisions and give orders for performing laboratory, scanning, and radiological investigations. She should have potential to implement special analyzing of health cases to enhance collect diagnosing and management of healthcare problems.  She should have advanced planning and scheduling of patients for consultations, clinic checks with other sectors. She has to coordinate community awareness by initiating and coordinating public treatments and health education on individuals, families, and communities for their health promotion, disease prevention and immunization (Kim, & Mary, 2013). 

Mary should ensure that all stakeholders follow all principles, standards, and policies required in health education. She should observe protocols in the assessment of documents, diagnosing, and monitoring treatment as well as follow-up all members. She must have the potential to detect changes in patient conditions to prevent any possibility of having more complications on patient’s health. Mary must have qualities of maintaining clean and well furnished medical environment. She must have been ready to dispense medication services according to authorized scope of practices, procedures, guidelines, protocols and regulatory framework.  Ethical issues and practices must be applied in all aspects of APN (Kim, & Mary, 2013). She must be accountable, responsible and liable for every activity, duty, and obligation within her area of jurisdiction.

In the health sector, there are special branches of nursing levels where Mary requires ensuring she can offer support. They include

  1. Acute care APN's practice within intensive care units and other emergency sections like accident scenes
  2. Medical and surgical APNs that involve various activities such as general and specialized clinical units and functions like oncology, gerontology, neurology, and cardiology (
  3. Mental health APNs where health professional attend to both inpatient and outpatient medication support through arranging psychiatric setting at private and confidential environments (


References Advanced Practice Nurse. Retrieved from:

Kim L., M. & Mary E., A. (2013). ICN Nurse Practitioner/ Advanced Practice Nursing Network. Retrieved from:

Thursday, 22 February 2018 11:58

Historical Epidemiological Events

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Vitamins and Nutritional Diseases

In early 1800, bacteria were known to be main causes of diseases. Through the discovery of microorganisms and c how they were related to diseases new threatening causes of diseases were identified. Diseases such as beriberi, rickets, and pellagra were still dominating the world. However, biochemistry research studies and investigations were being conducted. In 1880, it was observed that when a young mouse was fed purified diet comprising of vitamins they died very quickly in contrast when they were fed with milk they flourished. Naval surgeon T. K. Takaki cured beriberi in 1887 of Japanese Navy through adding vegetables, meat, and fish to rice. In 1889 it was discovered that lion cubs were cured of rickets through feeding them crushed bones, milk, plus cod liver oil (Zhang, & Wu, 2010). First epidemiological impact in deficiency illnesses was discovered in 1886 when Eijkman observed that chickens fed on polished rice, suffered from beriberi. Chickens recovered when their diet was changed to feed on whole rice (Lee, et al., 2013). Physiologists discovered that beriberi was caused by lack of essential substances found in an outer layer of rice grain.

In 1906, Fredrick Gowland Hopkins researched on the pathogenesis of rickets and scurvy. Thro-ugh his research he explained that other forms of nutrition components existed and were essential for good health. Casimir Funk isolated chemical compound called amines in 1911; he added Latin word vita which is a word for life.  E.V. McCollum revealed that two factors were essential for growth of rats, a fat soluble “A” found in butter and fats and water soluble “B” found in nonfatty food like grains of rice (Lee, et al., 2013). Such discoveries led to a process of labeling vitamins by alphabetical letters. Heat stable factor was identified as responsible for curing rickets. Heat labile factor was capable of curing dryness of conjunctiva (xerophthalmia) that leads to the disease on the mucous membrane of the eye resulting in a deficiency of vitamin A. heat-stable factor was referred to as vitamin D, while heat labile factor was referred to as vitamin A.

Discovery of vitamin D led to linking of an observation made concerning rickets and cod liver oil. It cured rickets since it contained vitamin D. It was observed children exposed to sunlight were less likely to experience rickets. Kurt Huldschinsky proved that exposing children suffering from rickets to sunlight-cured rickets. This was due to the production of vitamin D in the body in the presence of sunlight since sunshine acted on fats. Antiberiberi factor referred to as vitamin B was also discovered as a cure for pellagra (Zhang, & Wu, 2010).

Currently, social, economic factors have contributed to increased number of deficiency diseases as a result of lacking balanced diet. Poverty conditions are currently major contributions to poor health. Pioneers in epidemiology have introduced and discovered germ theory, microscope equipment, vaccinations, and modern ways of diagnosing diseases. Earlier technologies have highly promoted good health in society through providing parents with better schedule and plan for health food. Such trends have led to current growth and development of improved healthy sector, by defining feeding habits of patients with complications. Compared with traditional living standards, epidemiology has improved nutrition problems by reducing the number of children suffering from deficiency diseases. Discovery of vitamins has equipped society with optional meals right for their health.



Lee, S. W., Devlin, J. M., Markham, J. F., Noormohammadi, A. H., Browning, G. F., Ficorilli, N. P., Hartley, C. A., ... Markham, P. F. (2013). Phylogenetic and molecular epidemiological studies reveal evidence of multiple past recombination events between infectious laryngotracheitis viruses. Plos One, 8, 2.)

Zhang, H. L., & Wu, J. (2010). Role of vitamin D in immune responses and autoimmune diseases, with emphasis on its role in multiple sclerosis. Neuroscience Bulletin, 26, 6, 445-54.

Thursday, 22 February 2018 11:46

Nursing Shortage and Nursing Turn Over

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There are many descriptions of the status of nursing workforce shortage in present as well as future. The surrounding of nurse shortage remains complex and interrelated.  Hence, isolating single factors or solutions for this problem is difficult.  Instead, a systems perspective review gives the greatest depth and understanding of the relationships between multiple variables. It remains critical to encompass the systematic aspects of education, work environment as well as health delivery systems. Additionally, the reimbursement impact, legislation, regulation as well as technological advances need to be put into consideration. Inadequacy in considering the relationships in these aspects hinders the full appreciation of the nurse shortage complexity (Porter-O'Grady & Malloch, 2016).

            Addressing this problem takes both leadership and management dimension. The alliance of autonomous nursing organizations focused on leadership for education, practice as well as research remains critical. While the organizations can have individual constituent membership as well as the unique mission, unity by common values and regularly convening dialogue as well as consensus building is important. The alliance's diverse interests encompass nursing job environment, health legislation and policy, quality of health care, nursing education, practice, research as well as leadership in all parts of health care system (Feldman, 2003). This alliance captures the total nursing's social, political, professional as well as moral authority nationally and internationally as a way of influencing and providing stewardship in the nursing profession. The organizations represent the nurses in practice, nurse executives as well as nursing educators. Therefore, while organization can help in leading the nursing profession to stick to their roles in providing health care, executives or managers need to make the nursing work environment a good place for nurses. This can help to reduce nurse shortage as well as turnover. Nurse shortage affords opportunities, but there exist consequences, too. Some nurses always need to work for long hours in stressful conditions, which can cause injury, fatigue as well as job dissatisfaction. Nurses who suffer in such environments are more likely to make mistakes as well as medical errors. As a result, patient quality can end up in suffering.  As a result of this, and more, nurse managers need to be dedicated to improving workplace safety for nurses across the nation.

            On the other hand, massive reductions in budgets for nurses, combined with challenges brought by an increasing nursing shortage can result in fewer nurse working longer hours and care for sicker people. This aspect in the nursing environment can easily compromise care. It also contributes to the nursing inadequacy through the creation of an environment which drives nurses from bedsides. In the United States, among the most critical problems that lead to nurse shortage and turnover is the aging of nurses as well as nursing faculty. The current average age of employed RN stands at 43.3 years, with registered nurses below 30 years representing just 10% of all working nurses. Nurse leaders need to take up this initiative by becoming forecasters of nurse shortage .hiring of new nurses must be tailored at solving future shortages. This strategy remains a responsibility of nurse leaders. Therefore, while managers need to ensure working environment for nurses is healthy, leaders need to see the future and come up with initiatives that can reduce shortages and turnover among nurses. The nurse leaders and managers need to recognize that other people have concerns about the nursing shortage and that different stakeholders continue to identify gaps, make recommendations and implement strategies that address nurse workforce issues. However, to succeed in encouraging development and deployment of nurse personnel with skills knit to health care system, the people, policy makers as well as a profession need to have an ongoing long-term planning, irrespective of perceived or real forces relating to the short-term need for nurse services. Without initiatives to change the trends nurse issues, people become exposed to dangers of facing adverse breakdowns in health care system. Strategies for recruiting and retaining remain costly and must be practiced with the assurance that the efforts can get accompanied by particular strategies in overcoming workforce problems that hinder long-term career commitment in nursing.

            When it comes to nurse leaders, there are some strategies that can help to handle shortage and turnover.  Leaders can implement strategies to retain experienced nurses in providing direct patient care. This can include Introducing of greater flexibility in work environment structure as well as scheduling programs. They can also reward experienced nurses for working as mentors and preceptors for new nurse hires. They can also implement appropriate salary as well as benefit programs. Leaders can also create partnership environment which can advance the practice of nursing through the establishment of appropriate management structures in the health care system and ensure adequate nurse staffing.  They can also provide nurses with enough autonomy over their practice in all situations.  Since leaders need to be influencers, they can also redesign work to enable aging workforce to remain active in some direct care pursuits (Laurent, 2000). Leaders can also advocate for increased funding for nursing education funding under the Public Health Service Act as well as other publicly funded programs to enhance the capacity as well as resources for the education of appropriate enough workforce. Advocacy on the identification of nursing services in Medicare, Medicaid as well as other reimbursement systems can also be a leadership strategy that can solve nurse shortage and turnover.

            Since managers are supposed to make things work well in an organization basing on the current resources, they can address nurse shortage and turnover using different means. They can investigate the potentials in utilizing technological advances in enhancing the capacity of reduced nurse demographics. They can also support initiatives in workforce planning through Division of Nursing as well as other public and private organizations to come up with models for personnel health planning that consider the need as well as nursing services demands (Blake, 2012). Managers can also promote the consistent collection of data at national, state as well as the local level to account for variation in all level to enable better nurse workforce planning for nurses. Nurse Managers can also help in developing career progression initiatives as a way of moving nursing graduates in graduate studies more rapidly and identify different option beyond the entry-level role like faculty, researcher as well as an administrator. Health managers can also support health care employers in creating and sustaining staff development programs as well as lifelong learning for long-term competence.

            On my job, rapid turnover is caused by the demand of highly trained specialized nursing skills in the emergency room. Nurses get faced with the competition of higher benefits and salary to meet their experiences and skill, so they hop from job to job for personal fulfillments. From my personal as well as professional philosophy of nursing, visionary leadership remains most appropriate in handling nurse shortage and turnover to create a new direction in nursing.  Visionary leadership’s goals can move nurses towards a new set of healthcare stakeholders’ shared dreams.  I perceive nursing profession as a calling that the society has great demand on it. Visionary leadership articulates where people go and not how to get there. It, therefore, sets people free to innovate, experiment and calculate input risks. This approach suits my leadership style because it provides an opportunity for a multidimensional approach to issues to promise a better tomorrow. Particularly on nursing shortage and turnover, leaders and manager can pursue different strategies from educational, legal as well as economic dimension to handle nurse issues in a sustained manner.



Blake, N. T. (2012). The relationship between the nurses' work environment and patient and nurse outcomes

Feldman, H. R. (2003). The nursing shortage: Strategies for recruitment and retention in clinical  practice and education. New York: Springer Pub.

Laurent, C. L. (January 01, 2000): A nursing theory for nursing leadership. Journal of Nursing Management, 8, 2, 83-7

Porter-O'Grady, T., & Malloch, K. (2016): Leadership in nursing practice: Changing the landscape of health care.



Studies have revealed that nature, as well as other causes of low birth weight of babies (LBW), contributes increased birth rate of infants with reduced weight. Environmental conditions can lead to the development of certain conditions that may contribute to infants being born having reduced weight below normal standards. A normal infant should weigh 2.5 Kilograms. Babies below 2.5 kg at birth are considered having low birth weight. However, several factors may contribute towards giving birth to a baby with low birth weight. Hence the article describes nature and causes of low birth weight of babies.

Among the factors that lead to giving birth to babies with LBW include

  1. Genetic constitutional factors are usually related to geographical areas, inherited genetic materials, and environmental factors that contribute to mutation of genes. LBW may there result due to variation in infant sex, race or ethnic origin for example Africans-Americans parents have the high likely hood of giving birth to LBW infants. Other factors include maternal height where parents have a small body in size, maternal pre-pregnancy weight, maternal hemodynamic and paternal height and weight (Kramer, 1987).
  2. Demographic and psychosocial factors such as maternal age where the expectant mother may be too young (Under the age of expectancy) as well as old mothers (above the age of expectancy) may give birth to babies below 2.5 years (Carlos, & Marilia, 2013). Marital status singles and divorced, maternal psychological factors, and social, economic statuses like a low level of education, energy involving occupations, and women under poor sources of income register a high rate of LBW (Helen et al., 2006).
    1. Obstetric factors contribute to giving birth to infants with low birth weight contributed by the very small gap between birth and pregnancy interval. Aggressive sexual activities, slow rate of intrauterine growth and small interval of gestation about prior pregnancies contribute to the increase of LBW. Women who may have practiced prior spontaneous abortion or engages in inducing abortion have characteristics of giving birth to LBW babies. Women who have experienced prior stillbirth, neonatal death, infertility and Utero exposure to diethylstilbestrol have high chances of giving birth to LBW baby (Chen et al., 2015).
    2. Maternal morbidity during pregnancy that determines health conditions of the expectant mother may contribute to weight conditions of an infant. Expectant mothers who experience general morbidity and episodic illnesses such as suffering from malaria, urinary tract infection and genital tract infection have registered records characterized by giving birth to babies with LBW (Arnaud, & Vincent, 2007).
    3. Toxic exposure to environments or areas with high concentration of toxic chemicals has a high risk of making their child suffer from LBW (Arnaud, & Vincent, 2007). In general, mothers who are exposed to cigarette smoking, alcohol consumption,use of caffeine and coffee consumption have registered highest possibilities of giving birth to LBW babies. Women who engage in the consumption of strong drugs such as the use of marijuana, narcotic addiction, and other drugs may give birth to LBW babies.
    4. Constant visits and attendance to antenatal care may contribute to the weight of a baby at birth. Expectant mothers who ignore antenatal care visit have high chances of giving birth to a baby with less than 2.5 kg. Irregular or minimal number of visits to antenatal care may result to low weight babies at birth (Tessa, et al., 2004). Poor and lack of getting quality antenatal care is a factor that can cause expectant mothers giving birth to babies with less than 2.5 kg.

    Thrifty genes are a body condition of body influenced by physical activities, type of nutrition, and periodic seasons in a region. Mothers who inherit or develop thrifty genes may give birth to babies below 2.5 kg due to the development of conditions such as thrifty phenotype hypothesis or small baby syndrome. Research has revealed that expectant women living near hydraulic fracturing sites give birth to babies with LBW. According to a research report released by University of Pittsburgh Graduate School of Public Health reflected mothers are living within homes located high-density emissions of fracking gas such as oil fumes, and gas companies, are 34% more likely to have babies with small gestation period (David, 2015).  


    As recorded there are several factors that contribute to expectant mothers giving birth to young babies with reduced body weight.Other problems that may contribute to LBW include problems with placenta such as a pre-eclampsia condition that reduces blood flow to a fetus. Expectant mothers diagnosed with high blood pressure may become victims of giving birth to LBW babies. Mothers expecting to deliver twins or more babies have the high likely hood of giving birth to small babies with less than 2.5 kg due to a small room of growth in the womb. Other health complications may contribute to giving birth to LBW babies. Inherited medical conditions such as health or emotional problems may slow down baby growth and development leading to reduced birth weight.  


    Arnaud C. & Vincent O. (2007). Mother’s Education and Birth Weight.  Retrieved from

    Carlos A. N., & Marilia B. G.,(2013). Low Birth Weight: Causes and Consequences retrieved from

    Chen Y., Wu l., Zhang W., Zou L., Li G., & Fan L., (2015). Delivery Modes and Low Birth Weight Infants in China. Retrieved from

    David M. (2015). Fracking May Cause Lower Birth Weights in Babies.

    Helen A., Jennifer S., Sara B., & Kevin B. (2006). Unequal at Birth: Inequalities of low birth weight babies in Ireland Retrieved from

    Kramer M.S. (1987). Determinants of Low Birth Weight: Methodological Assessment and Meta Analysis. Retrieved from

    Retrieved from

    Tessa W., Ann B., Jelka Z. & Elisabeth A.,(2004). Low Birth Weight County regional and Global Estimates. Retrieved from

Thursday, 22 February 2018 05:30

Evidence-Based Pharmacy Paper

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Chronic obstructive pulmonary disease (COPD) is a disease that affects the respiratory system and characterized by chronic airway inflammation. The airflow limitation problem is not fully reversible. The disease cause severe and frequent exacerbations and reduced lung function. Most cases related to the disease are under-diagnosed and not effectively treated. The burden of dealing with COPD is high in the global perspective, and it is estimated that by 2020, it will increase to the rank of 5 for disease burden and 3 for the cause of death (Tugaut, Hennig, Lambert & Tschiesner, n.d). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends that the assessment of COPD be based on the level of symptoms, exacerbation history, the severity of spirometric abnormality, and the identification of co-morbidities. Spirometry is a requirement for the diagnosis of COPD, but the management and diagnosis should not be entirely based on the method. The reported outcomes by the patient by their symptoms, activity limitation, or health status are essential in assessing disease severity and treatment impact. The main purpose of the evidence-based paper is to review the relevant information in the diagnosis and treatment of COPD as well as developing a follow-up plan and referral.

Pathophysiology of COPD

COPD is a complex condition that affects the ability to breathe, hence deadly. The pathophysiology of the disease starts with the damage of the airways and the air sacs in the lungs. The result is a cough with mucus and difficult breathing. The damage caused by the disease is irreversible, but prevention can lower the risk of the developing COPD. Chronic lung diseases are diverse, but the common are chronic bronchitis and emphysema that affect different parts of the lungs resulting in difficulty in breathing. A clear understanding of COPD’s pathophysiology requires a vivid understanding of the structure of the lungs. Upon inhalation, the air moves to the trachea through bronchi that branch into smaller tubes called alveoli that house the capillaries with minute blood vessels. Emphysema is a disease condition that affects the alveoli in which the fibers in the walls of the alveoli are impaired. They become less elastic and unable to work upon exhalation. When the bronchioles are inflamed, they produce more mucus, a condition called bronchitis whose persistence cause chronic bronchitis.

The major cause of COPD is smoking in which smoke and other chemicals injure the airways and the air sacs. The exposure to secondary smoke, chemicals, and cooking oils in poorly ventilated rooms may also lead to lung diseases (Browne, Aslam, , 2011). The main issues associated with COPD are airway inflammation, mucociliary dysfunction, and airway structural changes (Tuder & Petrache, 2012). Airway inflammation covers the lung tissues and the pulmonary blood vessels due to exposure to the inhaled irritants. They cause inflammatory cells like neutrophils, CD8+ T-lymphocytes, B cells and macrophages to accumulate. Upon activation, the cells have an inflammatory cascade that triggers the release of inflammatory mediators such as tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), matrix-metalloproteinases (MMP-6, MMP-9), C-reactive protein (CRP), interleukins (IL-1, IL-6, IL-8) and fibrinogen. They sustain the inflammatory process leading to tissue damage and a range of systemic effects. The inflammation leads to diverse structural changes in the lung that perpetuate airflow limitation (Macklem, 2010).

The structural changes associated with COPD include airway remodeling which is a result of the inflammatory response leading to narrowing of the airways. The factors that contribute to it are peribronchial fibrosis, the build-up of scar tissue from damage to the airways and increased multiplication of the epithelial cells lining the airways. Also included is parenchymal destruction associated with the loss of lung tissue elasticity that occurs as a result of the destruction of the supportive structures of the alveoli. The airways collapse during exhalation that hinders airflow and traps air in the lungs reducing lung capacity (Tuder & Petrache, 2012).

Mucociliary dysfunction is as a result of smoking and inflammation that enlarges the mucous glands in the airway walls of the lungs. It causes goblet cell metaplasia leading to the replacement of the healthy cells by more-mucus secreting cells. The inflammation due to COPD causes damage to the mucociliary transport system whose work is to clear mucus from the airways. The result is excess mucus in the airways that accumulates blocking and worsening the airflow.      

Figure 1: Mucociliary effects in the COPD airway, Retrieved from 

Genomic Issues inherent to COPD

Chronic Obstructive Pulmonary Disease is a complex genetic disease in which some environmental factors interact with different polymorphic genes to influence susceptibility. COPD has influences from race, ethnicity, gender, and genetic factors (Silverman, Spira & Paré, 2009). There is limited data to compare the different racial and ethnic groups, but it is evident that the differences in COPD exist. The likely differences in COPD between the ethnic and racial groups include the genetic and biological differences, disparities in diagnosis and treatment methods, increased exposure to cigarette smoking for the non-white populations, and lack of screening and participation in clinical trials for the minorities. Gender influences COPD in which men have higher prevalence rates than women but the trends are changing with time. The COPD experienced by women may have different characteristics than in men and may be more severe. In the United States, the reported deaths for COPD are high for women than for men (Dransfield, Davis, Gerald & Bailey, 2009).

The differences in the lung function and risk for COPD in people with similar cigarette smoking histories alongside familial aggregation supports an important role for genetic risk factors in COPD. Some COPD cases associated with α1-antitrypsin deficiency (AATD) harbor a significant genetic determinant. The condition is more common in the populations of Northern European ancestry, but can also be found in other regions. Other genetic determinants of COPD are difficult to establish as the case with other complex diseases. The commonly used genetic methods are the studies involving association analysis of pathophysiological candidate genes. The results are not consistent, but the majority of them have not been well replicated though a few genes have consistent positive results. The animal studies have been effective in analyzing the COPD-related molecular pathways and provide a source of candidate genes for association analysis. The genome-wide approaches present an unbiased approach to identify effective COPD susceptibility genes. The studies linked to humans performed in COPD have led to the discovery of several genomic aspects of interest and the novel COPD associated gene, SERPINE2 (Silverman, Spira & Paré, 2009).

The significant genetic differences between racial and ethnic groups result from Novel genetic risk factors present in certain populations, shared genetic risk factors with varying prevalence among populations, and the genetic risk factors with different effects due to diverse gene-by-environment interactions.           

Basics of COPD and its treatment methods

Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases that block the airflow in the lungs resulting in difficulty in breathing. Most of the symptoms related to COPD are similar to those of asthma. COPD is the leading cause of death and illness worldwide but is preventable. The long-term cigarette smoking is the major cause of the life-threatening disease since the smokers are likely to suffer from both asthma and COPD. The treatment approach of the two conditions is different, hence important to learn their basics.

An approximate of 12 million people in the United States has been diagnosed with COPD. Others may be affected, but do not know about it until severe symptoms arise. The Center for Disease Control and Prevention (CDC) reports that COPD is the fourth leading cause of death in the United States and its prevalence increases with age with men being the most affected. COPD causes several changes in the lungs and the airways. The air sacs and airways lose the ability to stretch, the walls of the sacs are destroyed, the walls become thickened, and the airways become clogged with mucus.

The two main forms of COPD are chronic bronchitis and Emphysema. Chronic bronchitis is an inflammation of the air passages with airflow obstruction. The condition involves a long-term cough and mucus taking most days of the week for three months in two progressive years. Emphysema entails the destruction of the lung tissue called the alveoli. Both forms interfere with the absorption of oxygen and the release of carbon dioxide. There is no cure for COPD, and there is no reverse on the damage caused. However, treatment and lifestyle changes reduce the progression of the disease.     

The serious disease symptoms of COPD do not show until the advanced stages. COPD affects the health of the lungs and the patient experiences breath shortness after a minor physical exertion. A patient who breathes more than usual after engaging in the normal activities ought to visit a doctor (Tuder & Petrache, 2012). A major reason for the challenges in breathing is the production of mucus in the lungs. Less oxygen is inhaled due to accumulated mucus in the airways. As COPD progresses, several other health complications follow. The patient may experience wheezing when breathing. The accumulation of mucus and the narrowing of the bronchioles cause chest tightness. The common treatment methods for COPD are the use of medications, oxygen therapy, non-invasive ventilation, and surgery as later discussed. None of the treatment methods is a sure guarantee of recovery since the damage due to COPD is irreversible.          

Approach to information gathering

A search for the relevant and updated information about COPD was performed using a predefined search strategy to identify evidence-based research studies with COPD-related aspects. The search includes different databases that include MEDLINE, MEDSCAPE, Cochrane Library, CINAHL, and EBSCO Host Academic Search Premier. The systematic secondary searches focused on the American Lung Association website, the Center for Disease Control and Prevention as well as the World Health Organization.

The search for information involved the use of keywords that helped to refine the search to the most appropriate and updated articles. It was necessary to specify the search criteria by selecting the year duration, and the type of articles as peer reviewed. The keywords used are COPD, diagnosis, and treatment of COPD, pathophysiology of COPD, COPD symptoms, COPD medications, and COPD referrals. It was necessary to refine the search using the Boolean operators “AND” and “OR” in some databases to generate more relevant information.       

Approach to the treatment of COPD and the alternatives

The major symptoms of COPD are breath shortness, coughing, production of a yellowish phlegm, fatigue, and frequent respiratory infections.  According to the American Lung Association, the diagnosis of COPD involves the evaluation of the symptoms, assessment of the complete health history, and conducting a health examination. For the health history, the doctor wants to know the smoking status and history, exposure to secondary smoke, chemicals, dust, and air pollution. It is necessary to check on the symptoms of breath shortness, chronic cough or mucus as well as assessing family history about COPD (Fromer, 2011).

The testing for COPD uses spirometry which is a simple test of how well the lungs work. The patient blows air into the mouthpiece and tubing connected to a small machine. The machine measures the amount of air blown out and how fast to blow it. The method helps to detect COPD before the symptoms arise and the physician can use the results to identify the severity of COPD for effective treatment goals. The other tests include chest X-ray and arterial blood gas test. The test measures the level of oxygen in the blood and shows how well breathing occurs.

After diagnosis with chronic obstructive pulmonary disease (COPD), the doctor develops a suitable treatment plan in line with the symptoms. There is no best medication for COPD, but the doctor and the health care team ensure that they set a plan that addresses the symptoms and needs of the patient. The right medication helps the patient to breathe better and have fewer flare ups.

Several treatments can improve the symptoms, reduce the flare-ups, and also improve the energy levels. The most important treatment for smokers is quitting smoking to stop the ongoing damage to the airways. The hairs in the airways can work efficiently to clear mucus, bacteria, and all the poisonous chemicals accumulating in the lungs. The people with a lung condition ought to have a proper diet to prevent infections and keep the lungs healthy. The overweight people have difficulty breathing and also moving around. A healthy lifestyle includes being active and taking regular exercise as well as having a balanced diet (Grembiale, Naty & Ursini, 2010).

The treatment of COPD can be accomplished by use of medications, oxygen therapy, non-invasive ventilation, and surgery. The common medications include bronchodilator inhalers, steroid inhalers, and use of mucolytic and antibiotics. Bronchodilator inhaler is a short-acting medication that relaxes the muscles in the airways to keep them open and relieve breathlessness. Steroid inhalers help to reduce swelling in the airways for long-term use and reduce breathlessness and exacerbations. Mucolytic medication helps to reduce the thickness of the phlegm, and the antibiotics prevent infections. The side-effects to the inhalers are minimal since the doses are small (Fromer, 2011). 

Combinational therapy involves using medications of different classes as appropriate and delivering treatment to obtain better results. The data from the trials of combining the long-acting inhaled beta agonists and inhaled corticosteroids cause a significant impact on pulmonary function and a reduction in symptoms in those receiving combination therapy compared with its components. The patients with exacerbations who use the combined treatment show improved results than using either of the component drugs in isolation.    

Oxygen therapy is useful when the level if oxygen in the blood is low when resting, or if the level drops when active. The therapy helps to increase the amount of oxygen flowing to the lungs and the bloodstream. COPD causes changes in the oxygen flow, hence necessary to undergo the therapy depending on the patient needs. Non-invasive ventilation is a machine that supports breathing. The treatment method involves the use of a mask covering the nose or the face and connected to a machine that drives air into the lungs. The method of treatment increases the level of oxygen and helps patients to breathe out carbon dioxide. The machine reduces breathlessness since it eases the chest muscles. Surgery can be effective to the people whose airwaves are very narrow to remove the damaged areas of the lung. Patients with COPD and whose conditions do not improve can opt for a lung transplant. However, the limitation of organ donors and the risk of the operation make transplant unusual (Fromer, 2011).

A non-pharmacological method of treatment of COPD is the use of pulmonary rehabilitation. Pulmonary rehabilitation programs combine education, exercise training, nutrition advice and counseling. The rehabilitation is a multidisciplinary program of care for the patients with chronic respiratory problems. The rehabilitation program results in improvement in the areas of importance to the patient that includes dyspnoea, exercise ability, health status, and health care utilization. The effects arise in spite the fact that it has minimal effect on the pulmonary function measurements. Pulmonary rehabilitation is appropriate for the patients with dyspnoea and other respiratory symptoms, reduced exercise tolerance, and impaired health status (Miravitlles, Soler-Cataluña, 2013).   

The less oxygen that circulates in the body leaves the body fatigued in which lack of energy can have an association with other conditions. For the serious cases, COPD patients experience weight loss. Following the progression of COPD disease, it is necessary for healthy people to prevent it since it has no known cure. The easiest method to prevent COPD is never to smoke. The longer an individual stays without smoking, the greater the chances of avoiding COPD. An importantaspect in COPD management is having regular checkups and following the advice from the health care providers to prevent the disease. The proactive steps help to maintain better lung function and health.          

There are several treatments that can improve the symptoms, reduce the flare-ups, and also improve the energy levels. The most important treatment for smokers is quitting smoking to stop the ongoing damage to the airways (Browne, Aslam, Jones, Flint, Dzingai, Fabris & Stern, 2011). The hairs in the airways can work efficiently to clear mucus, bacteria, and all the poisonous chemicals accumulating in the lungs. The people with a lung condition ought to have a proper diet to prevent infections and keep the lungs healthy. The overweight people have difficulty breathing and also moving around. A healthy lifestyle includes being active and taking regular exercise as well as having a balanced diet (Miravitlles, Soler-Cataluña, 2013).  

Follow-up treatment and referrals

The complementary therapies applicable during follow-up include philosophies and practices that are not considered conventional in the United States. The complementary therapy includes massage, yoga, and acupuncture which do not treat COPD but improves the symptoms and quality of life. Palliative care is also a form of support offered to help in managing the chronic obstructive pulmonary disease. The type of care helps to achieve the best quality of life and is appropriate for all the people living with COPD. A palliative care team helps the patient in taking medications and therapies to ease discomfort like anxiety and breathing problems, educating on lifestyle changes during COPD, as well as medication and disease management. The major benefit of palliative care is to improve the quality of life and help to relieve the physical and emotional symptoms as well as communicating with the care providers.

Referral to a specialist care is necessary for COPD patients with the disease onset at age less than 40 years and with frequent exacerbations. The patients may have undergone adequate treatment but have a rapidly progressive course of disease characterized by declining FEV1, progressive dyspnoea, decreased exercise tolerance, and severe COPD. The patients experience the effects despite having optimal treatment. Some of the patients develop a co-morbid illness like osteoporosis, heart failure, bronchiectasis, and lung cancer. 



Browne, J., Aslam, N., Jones, E., Flint, B., Dzingai, J., Fabris, G., & ... Stern, M. (2011) Stop smoking as treatment for Copd: Quit-Interventions of Higher Intensity and Duration Are Required; Thorax, A117-A118, doi:10.1136/thoraxjnl-2011-201054c.125

Dransfield, M. T., Davis, J. J., Gerald, L. B., & Bailey, W. C. (2009) Racial and gender differences in susceptibility to tobacco smoke among patients with the chronic obstructive pulmonary disease. Respiratory Medicine, 100(6), 1110-1116.

Fromer, L. (2011). Diagnosing and treating COPD: Understanding the challenges and finding solutions. International journal of general medicine, 4, 729.

Grembiale, R. D., Naty, S., & Ursini, F. (2010). Chronic obstructive pulmonary disease (COPD) treatment in the elderly: BMC Geriatrics, 10(Suppl 1), L83.

Macklem, P. T. (2010). Therapeutic implications of the pathophysiology of COPD: European Respiratory Journal, 35(3), 676-680.

Miravitlles, M., Soler-Cataluña, J. J., Calle, M., Molina, J., Almagro, P., Quintano, J. A., ... & Ancochea, J. (2013). A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD guidelines (GesEPOC). Primary Care Respiratory Journal, 22, 117-121.

Silverman, E. K., Spira, A., & Paré, P. D. (2009) Genetics and Genomics of Chronic Obstructive Pulmonary Disease: Proceedings of the American Thoracic Society, 6(6), 539–542.

Tuder, R. M., & Petrache, I. (2012). Pathogenesis of chronic obstructive pulmonary disease:The Journal of clinical investigation, 122(8), 2749-2755

Tugaut, B., Hennig, M., Lambert, J., & Tschiesner, U. Relationship between FEV 1 and Patient-Reported Outcomes Changes: Results of a Meta-Analysis of Randomized Trials in Stable COPD. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 3(2), 519-538.

Wednesday, 21 February 2018 11:48


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The concept lower back pain, with and without accompanying lower limb symptoms

 Low back pain is also known as Lumbago and is terms used interchangeably. Understanding the main cause of low back pain is not always readily apparent and is a complex aspect of establishing the main cause of low back pain due to crucial factors that guides physicians in establishing a preliminary diagnosis are: a.) the pain distribution area that is where the patient feels the pain. It can be in the low back or when the patient has an accompanying leg pain that feels worse than the pain in the lower back or if the pain is from other parts of the body. B.) the low back pain type. It means a description of how the patient feels the pain. That is when it occurs and what makes it worse or better. There are several problems that cause lower back pain.          

The main principles of low back pain are that; the pain is not always a reflection of damage extent. For instance, a large herniated disc can be painless whereas a simply pulled or strained muscle on the lower back causes excruciating pain that hinders one from standing or walking. A second principle is that it is always difficult to diagnose low back pain. It is because there are several anatomical features low back structures that lead to back pain or even the fact that the pain is on the feet/ legs. The problems can occur at any part of the interconnected, complex network of the nerves, spinal muscles, tendons, disc or bones of the lumbar spine the common sources of pain are; 1The irritation of the lower back’s large nerve roots that join with the leg 2. The irritation of the smaller nerves that supply to the lower back. 3. The damage to joints, ligaments and bones, 4 Degeneration of the intervertebral disc 5 Straining of the erector spine which is the lower back muscles that are in pairs. Any problem or irritation on any of these structures causes lower back pain as well as pain that is referred or radiates to other body parts. Most problems of the lower back do cause spasms of the back muscle which can also contribute to severe disability and pain.

The low back comprises of anatomical structures such as the soft tissues like tendons, ligaments, and muscles. There are bones that give the lower back it's structural building the spinal column blocks. There is the facet joint that gives movement to the pine. The discs are also present that has the annuals and the disc outer rim that can act as a source of major low back pain for it has a rich supply of nerve and high tendency towards damage. The lower back also has nerves that come from the spinal cord and innervate the feet and legs.

 It is essential for patients and physicians to be accurate on the diagnosis of the low back pain to establish the underlying cause especially with the presence of the red flags or warning signs. These comprise on less weakness, loss of bladder or bowel control, significant numbness, fevers, chills, or unexplained significant weight loss. In a case where such symptoms are not present, then it is advisable to commence on the conservative treatment with no need of having an MRI immediate diagnosis.

 Finally, unlike other diseases or medical conditions, patients have different experiences of low back pain for others it can be a mere nuisance while others it becomes incapacitating. For most individuals, abnormalities of the spinal code such as degenerated disc are present in MRI scan, but they are painless. Also, other factors such as emotional, psychological (Tang, et al. 2007) and financial aspects influence or contribute to a person experiencing low back pain.


The difficulties associated with allocating a pathoanatomical diagnosis

 A physician determining the main cause of low back pain will employ both the area or location of pain distribution and the type of low back pain as part of the appropriate plan to help him or she make the preliminary diagnosis. It is often a major challenge for physicians to get the most accurate diagnosis to low back pain causes than usually expected. Finding an accurate diagnosis involves a physical exam, going tough the history of patients as well as some diagnostic tests. The physical exam and history are to help determine whether a patient’s pain of the lower back is from damages or problems of, the lower tissues. The lower tissues are the tendon, ligament, and muscles that usually heal themselves or to find the serious causes of the medical condition such as a tumor, infection, and fracture. When the physician makes an order of any MRI scan or x-ray, he or she will be having a strong suspicion of the likely cause of the patient’s condition. The tests will be for confirming this suspicion or provide more detailed information (Cox, et al., 2010).

The various methods employed in the assessment of lower back pain

The initial assessment of lower back pain aims to find the presences of any potentially risky underlying conditions. In the absence of such dangerous conditions signs, there will be no need for other extended assessments since 90% of such patients will spontaneously recover in a period of four weeks. A physical examination and focused medical history are accurate in assessing patients with recurrent or acute limitation as a result of the symptoms on the lower back that have occurred in a period of fewer than four weeks. Patient’s findings and responses from their physical and history examination provide a chance to establish the “red flags” that raise suspicions concerning the dangerous or serious underlying aspects of the spinal condition (De Souza, and Frank, 2011). The lack of such red flags rules out the need for more exams in the first four weeks since the symptoms are expected to recover spontaneously. The physical examination and medical history do help in alerting the clinician to other non-spinal pathology that is present in causing the symptoms of the low back pain.

The none- spinal pathology can be thoracic, pelvic or abdominal. The symptoms of acute low back fall into three main categories. 1. The serious spinal condition includes spinal fracture, infection, tumor, or a neurological compromise such as the syndrome of cauda equine which all suggest a red flag. A second category is the Sciatica that involves back-related symptoms of the lower limbs which suggest a compromise of the lumbosacral nerve root. The last category is the nonspecific back symptoms which mainly happen on the back, and they neither suggest a serious underlying condition nor comprise of the nerve root. Medical history can determine the presence of possible fractures such as a traumatic experience of a patient like falling from a height or a vehicle accident.

The medical history can also show minor trauma or strenuous lifting common in older osteoporotic patients. The back pain cause can also be established from the medical history to establish possible infection or tumor such as the age of patient i.e. under 20 or over 50, History of cancer, the presence of constitutional symptoms such as unexplained loss of weight, chills and fever. There are also risk factors that cause spinal infection such as IV drug abuse, recent bacterial infections such as UTI, and immune suppression from transplant, HIV, and steroids (Chou et al., 2007). The possibility of Cauda Equina Syndrome is identifiable by looking at the medical history of the patient such as saddle anesthesia, bladder dysfunctions and progressive or severe neurological deficit on the lower back. Physical examination has the limitation of not establishing possible infection or tumor or possible fracture causing the lower back pain. However, it shows the presence of Cauda Equina Syndrome (Chou, and Huffman. 2007). For instance the unexplained anal spinster laxity, perinea/Perianal sensory loss and significant motor weakness such as averters, ankle plantar flexors, and dorsiflexion ( the drop of a foot). Performing a physical exam and undertaking the patient history forms the McKenzie assessment. Both assessments are essential in gauging the impairment degree and for finding out the red flags that are contrary to the exercise-based treatments (Braun, Berg, Boehmn et al. 2011).

Key findings to differentiate serious pathology from mechanical lower back pain

 The low back pain is from various causes, and the serious sources can show similar symptoms. That means that it is usually challenging to different the underlying pathology of lower back pain in any musculoskeletal; evaluation (Sieper, et al. 2008). The mechanical back pain arises from the spine structure such as the spinal ligaments,  sacroiliac (SI) joints, zygapophysial joints, vertebral bodies, dura, paraspinal muscles, intervertebral discs, nerves and the spinal cord (Chien, and Bajwa, 2008).

The serious back pain such as the Inflammatory back pain is a complex symptom and not a condition. It commonly joints the inflammation of the joints of theses, spine and the vertebrae which are sites of the ligament and tendon attachment to bone. The possible sources of mechanical back pain are Osteoarthritis, derangement of facet joint,  degenerative dices of the disc, spinal stenosis, muscle imbalance,  Spondylolisthesis,  Herniated disc fracture from osteoporotic compression,  Severe kyphosis ¸Traumatic fracture,  Transitional vertebrae and Severe scoliosis. Possible sources that may contribute to inflammatory back pain are; inflammatory bowel disease, Psoriatic arthritis (PsA), Ankylosing spondylitis (AS), and Inflammatory arthritis (Rudwaleit, and Sieper et al. 2006). Other causes which contribute to either of the two -mechanical or inflammatory back pain are renal diseases, tumors such as metastases, abdominal aortic aneurysm, infections (like Osteomyelitis, Epidural abscess, Paraspinous abscess and Septic discitis) and gastrointestinal diseases.



De Souza, L and Frank A.  living with chronic back pain: the physical disabilities. Disability and Rehabilitation 2011;

Tang, NK et al. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res 2007; 16: 85-95

Sieper, J et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)Ann Rheum Dis 2009; 68:784-788

Chien, J, and Bajwa, Z.(2008) What is mechanical back pain and how best to treat it? [Journal Article, Review. Pain Headache Rep 2008 Dec; 12(6):406-11. Current pain and headache report 2

Braun, A Berg RM Boehm H et al. (2011). 2010 update of the recommendations for managing ankylosing spondylitis. Ann Rheum Dis 2011; 70:896-904. Ann Rheum Dis 2011;70:896-904 doi:10.1136/ard.2011.151027

Rudwaleit, M Metter, A,  Listing J and Sieper J et al. (2006) Inflammatory back pain in ankylosing spondylitis: A reassessment of the clinical history for application as classification and diagnostic criteriaArthritis Rheum 2006; 54:569-578

 Chou, R., Qaseem, V. Snow, D.., P. Shekelle, and D. K. Owens. "Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society." Ann Intern Med 147, no. 7 (2007): 478-91.

Chou, R., and L.  Huffman. Medications for Acute Low Back Pain: An Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline." Ann Intern Med147, no. 7 (2007): 505-14.

Chou, R., and L. H. Huffman. "Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an APS/American College of Physicians Clinical Practice Guideline." Ann Intern Med147, no. 7 (2007): 492-504.


Cox, H. Tilbrook, J. Aplin, A. Semlyen, D. la, and I. Watt. "A Randomised Controlled Trial of Yoga for the Treatment of Chronic Low Back Pain: Results of a Pilot Study." Complement Ther Clin Pract16, no. 4 (2010): 187-93.





Health promotion entails different levels of disease prevention which can be primary, secondary or tertiary. Primary prevention is useful before the occurrence of a disease, unlike secondary prevention which entails screening and diagnosis of a disease. Tertiary prevention seeks to rehabilitate the patient by addressing the risk factors. The discussion focuses on secondary prevention by use of diagnosis of breast cancer. The basis of the discussion is a case study of a 32-year-old mother of two with a history of smoking for the last fifteen years. Her family history revealed of a single paternal grandmother of breast cancer at age 52 and a history of abnormal cervical cancer screening three years ago.

            The screening test in consideration to suit the patient in diagnosing breast cancer is diagnostic mammogram. A mammogram is an x-ray of the breast. The diagnostic mammogram comes after suspicious results of the screening mammogram and signs of breast cancer. The mammogram helps to establish whether the symptoms identified are indicative of cancer. The use of diagnostic mammogram results to a more detailed x-ray of the breast. A woman who notices breast changes or symptoms from a suspicious routine mammogram requires a diagnostic mammogram (Gøtzsche & Jørgensen, 2013).

            The process of diagnostic x-ray involves the use of more x-rays from the breast to focus on specific areas than the screening mammogram. The x-rays give pictures of the breast tissue that are later read and interpreted by a radiologist. However, mammograms in isolation cannot be fully effective in confirming breast cancer. The tissue requires a biopsy using a microscope. The biopsy is the sure way to determine whether the breast has cancer. The diagnostic tests help to gather more information about cancer to guide the decisions about treatment.

            Mammography is the preferred standard of care in breast cancer screening. However, the method of testing is imprecise, and not all the cancers can be detected with mammography. In most instances, the use of mammographic findings in breast cancer diagnosis results classifies them as abnormal and hence necessary for a further diagnostic work (Bleyer & Welch, 2012). The accuracy of a mammography has an association with the prevalence and positive predictive values (PPVs) of the findings. The use of high or low PPVs leads to improved diagnostic, accuracy, and better prediction of the possibility of cancer before a biopsy.

            The ability of a mammogram tests to detect breast cancers depends on the tumor size, breast tissue density, and the level of expertise of the radiologist. Mammography has a less likelihood of revealing breast tumors in women younger than 50 years. Also, tumors appear white on the mammogram making it challenging to detect cancer (Canadian Task Force on Preventive Health Care, 2011). The validity of a screening test is its ability to distinguish the people at risk of a disease by use of specificity and sensitivity techniques correctly. Hence, the use of mammogram in breast cancer diagnosis is not a highly reliable method despite it being the most common among care providers.

            The sensitivity of mammography is approximate of 84 % especially in women 50 years and older. However, it has false positive results that sometimes turn out to be benign (Canadian Task Force on Preventive Health Care, 2011). The method is effective for breast cancer but is not perfect. There is a likelihood of missing breast cancer, hence necessary to use alongside other methods. The use of diagnostic mammography is a valid method for breast cancer diagnosis, but should not be used in isolation.    



Bleyer, A., & Welch, H. G. (2012) Effect of three decades of screening mammography on            breast-cancer incidence: New England Journal of Medicine, 367(21), 1998-2005

Canadian Task Force on Preventive Health Care (2011) Recommendations on screening for          breast cancer in average-risk women aged 40–74 years. Canadian Medical Association        Journal, 183(17), 1991-2001.

Gøtzsche, P. C., & Jørgensen, K. J. (2013) Screening for breast cancer with mammography: The   Cochrane Library


Wednesday, 21 February 2018 11:14

Health Organization Case Study

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Banner Health Network

Banner health network is one of the largest nonprofit hospital systems in the United States with over 35, 000 employees in seven Western states. Banner health network got founded in 1999 through a merger between Samaritan Health System, based in Phoenix Arizona and Lutheran Health Systems, headquartered in North Dakota. The healthcare system operates 29 different care facilities in small and large, rural and urban communities located in seven states and its headquarters is in Phoenix, Arizona. Banner health system serves over 300, 000 patients per year in the states of Alaska, Arizona, California, Colorado, Wyoming and Nebraska, and this number get expected to rise significantly. The health care organization offers a broad range of services that include home care, hospice care, hospital care, surgery centers, laboratories, rehabilitation services, neurosciences, orthopedics, emergency services, and nursing registries (Banner Health, 2016). The healthcare system also offers specialized services that include cancer treatment, heart care, high-risk obstetrics, level 1 trauma care, medical toxicology, high-order multiple births, organ transplants, rehabilitation services, behavioral health services, bone marrow transplants and behavioral health services. Banner is also a leading institution that undertakes research of some severe medical conditions that include spinal cord injuries and Alzheimer’s disease. The healthcare system achieves its objectives through an extensive commitment to their mission, “to make a difference in people’s lives through excellent patient care”. Banner health care has various awards and recognitions that include recognition by Thomson Reuters as a Top 10 hospital system in America, ranked 7th by SDI in Modern Healthcare magazine in the annual Top 100 Integrated Healthcare Network list, recipient of Gallup’s Great Workplace Award, etc. Banner healthcare organization has assets estimated to be 3.1 billion dollars and annual revenues estimated t 2.6 billion dollars. Banner Healthcare Network also offers over 153 million dollars in charity care through their Financial Assistance program.

Strategic Plan for Network Growth

Banner health network consistently seeks to enhance patient care and quality continually. With the mission statement “to make a difference people’s lives through excellent patient care”, the network aims at not only meeting future needs of the community but also expanding to other states. The vision for the care system is to be nationally recognized for its clinical excellence and innovations, hence strategically focuses on network growth. Through Banner healthcare network, known countrywide as an innovative leader in new healthcare models, insurance plans and physicians are coming together to operate together to ensure optimal health of its members, and at the same time minimizing costs. Banner health system collaborates with several commercial and government payers, as well as large employer groups, so as to deliver on the triple aim of lower costs, high-quality care, and an excellent patient experience. The organization is searching for technology to connect the patient with caregiver through telemedicine-based care delivery and a web portal that offers its member’s access to their medical data, enhances communication with Banner medical practices and allows users to manage their care in space and time appropriate to them. Network growth of Banner healthcare system through mergers and acquisitions has become a keystone of strategic planning for the organization. The health network has got involved in providing subsidized medical education costs for residents of Arizona and Colorado.

Strategic Plan for Nurse Staffing

Banner healthcare system seeks to enhance nurse staffing through integrating various strategies. First, it seeks opportunities in clinical care to stay current through the use of new and up-to-date technology, integrating, planning, and the use of electronic medical records. The use of electronic medical in healthcare facilities records the patients’ information that includes digital images, personally identifiable data, past medical history, communication from nurses, laboratory results, doctors and case management as well as visits. This data is available to the patient, medical physicians, and other authorized individuals at any required time and gets recorded accurately. Also, the Phoenix-based healthcare network has integrated a software model known as HIT value model that got applied in ordinary hospital processes so as to see the changes that the use of Information Technology (IT) would bring to the operational and administrative processes. The Intel HIT value Model resulted in 84 percent decrease in admissions for adverse drug reactions, 21.9 percent fewer medical complaints, 15 percent decrease in nurse turnover, 5.3 percent reduction in overtime claims, and 96 percent decrease in document storage expenses per 1, 000 records (Books, 2013). Also, on the Banner website, individuals can search for all available resources in different care facilities (Banner Health, 2016).

Strategic Plan for Resource Management

Banner health network actively engages in mid-year and yearly performance assessments from management. The performance evaluation was integrated into the system to assist Banner health meet and even exceed performances of other nationally recognized healthcare networks. The system allows Banner care system to review performance standards and clinical practice in areas that include ICU, stroke, Open-Heart Surgery and Heart failure and finally make comparisons of the outcomes with national standards. Acquiring this kind of information allows Banner health network to formulate policies and procedures as well as deliver the best care that will promote safe, quality patient care. Banner healthcare facilities in the community provide administration of vaccinations, injury and Xray analysis, general disease complaints, and women’s health issues, as well as providing access to physicians and other medical specialists. In Banner network, care managements systems assist in enhancing patient service and outcome.

Strategic Plan for patient satisfaction

Patient satisfaction and quality care in the United States have become great concerns in today’s managed care environment (Niles, 2014). For Banner health care system, patient satisfaction is a priority for various reasons. It increases compliance among staff members; they are responsible for the way hospital get reimbursed and offer data for national and state funding. Banner health uses the NRC Picker questionnaire and scoring for evaluating patient satisfaction. All units receive a quarterly report card of the Picker survey scores. Medicare also collects patient satisfaction scores through a survey known as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in which patient satisfaction survey formulated by Medicare gets sent to the patient and returned for assessment. Reimbursements get allocated on the care facilities depending on the satisfaction scores attained by the hospital. The banner health system has always achieved improved HCAHPS scores over the past three years.


Banner healthcare network is significantly focused on providing excellent patient care through the use of innovative technologies, training of the qualified workforce, continuous focus on enhancing patient outcomes and service and expansion of care facilities and services to meet community requirements. Banner health system has consistently provided its patients, staff member, and the community continuous access to safe, high-quality healthcare services, resources, and education. Banner health network continues to be one of the largest healthcare systems in the United States and also continues to grow through formulating a strategic plan for promoting nurse staffing, resource management, network growth and patient satisfaction.


Banner Health, (2016): Banner Health: Retrieved from

Books, H. I. M. S. S. (2013): Preparing for Success in Healthcare Information Management Systems: The CPHIMS Review Guide: Exam Prep and Comprehensive Resource in One!. HIMSS Books.

Niles, N. J. (2014): Basics of the US health care system. Jones & Bartlett Publishers.

Wednesday, 21 February 2018 09:27

re-engineering of health care

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Nurse Managers should assume the roles of being an example to other nurses, should reveal attributes of cooperating with other nurses within the area of jurisdiction. As a leader, he should have the ability to share information and helping nurses in their duties. He should have distinguished services by providing quality medical care that involves encouraging patients. They should have great influencing power in management, communication, and teamwork expertise. Nurse leaders must have good knowledge for promoting various fields of health such as finance, economics, accounting and emerging trends (Ross, 2011).

Leaders must have poses persuasive nature of communication. He should have the ability to encourage other nurses to change according to changes in technology. For effective and efficient output he must influence, negotiate, and persuade nurses to take up new technologies. Major strategies leaders should implement achieve better results include looking for professionals and experts that should share their expertise within nursing career (Ross, 2011). Delivery of services should be through high-level inspirations done through delegation of duties, sharing visions, helping other achieve greater goals. Low esteemed workers should be involved in more advanced duties and recognize individual efforts in support offered by low-level nurses (Ross, 2011).

Leaders should ensure that working environment guarantee best working ecosystem. They should be quick to listen to other nurses as they share their different working experiences.  Challenges encountered should be addressed through best way possible as well as implementing measures that mitigate, prevent, and protect nurses from any working stress (Ross, 2011). Nurse leaders should exercise their leadership power by promoting nursing practices that benefit patients. Privacy and confidentiality environments should be guaranteed to secure and reduce stigmatization of patients.


Ross B. G. (2011). The roles of leaders in high-performing health care systems. Retrieved from:

Provide an example of how you would apply CQI in your current or past position

Continuous quality improvement and Total Quality Management (TQM) are related. In health sector quality practices are vital and require to be implemented in most effective manner. One of the strategies involved while implementing continuous quality improvement involves

  1. Planning for a particular issue to improve
  2. Designing an effort to work identified within health sector
  3. Define processes involved in implementing a particular change to ensure that activities applied will trigger improvement. Perform analysis of current systems to ensure predicted activities make an effective and efficient change (Conner, 2014).

An example of QI project include coming with a project involves improvement methodologies for improving creation prevention that can lead to mitigating water-borne disease from affecting people. Water-borne diseases such as cholera can be prevented through use awareness strategies that create national and international campaigns against causes of water-borne diseases. The control measures can be tested through conducting research work in laboratories to reveal to people actual samples of infections caused by germs found in water (Conner, 2014). Educating people on numerous risk factors that lead to suffering from waterborne diseases can reduce increased spreading of infections during outbreaks. Some actions that can be applied include poor hand washing before using hands at meal time manipulation, inability to properly disinfect sources of water or sites that provide water for consumption.   Studies should reveal conditions of systems used to transport water as well as vessels applied for home use. Improvement driven should encourage people at home to implement better methodologies that guarantee that they are safe from consuming contaminated water. Treatment of drinking well as well as boiling and other safety measures should be highly encouraged.


Conner, B. T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6), 26-31.

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