Pharmacotherapy for Pneumonia

                Pneumonia is a respiratory condition that results to inflammation of the lung parenchyma. It is mostly caused by infections from microorganisms but it can also be caused by aspiration of foreign bodies into the lung. The bacterial causes include streptococcus pneumonia, which is the most common cause. Others include Chlamydia pneumonia and Mycoplasma pneumonia. Other causes include respiratory syncytial virus, histoplasma capsulatum and parasites such as pneumocystis carinii. A patient who is suspected to have pneumonia may present with fever, cough, running nose, tachypnea, and chest pain. On auscultation the client may have crackles or even wheezing. Chest radiograph will be used to confirm the diagnosis (Rajpurkar et al.,2017).

            Pneumonia can be treated with different medication depending on severity of the condition. For patients who have mild pneumonia amoxicillin is given. This are individuals who does not require any hospitalization. Other alternatives of the medication include cefuroxime axetil or amoxicillin/clavulanate (augmentin). For other forms of pneumonia such as the atypical pneumonia caused by the Chlamydia pneumoniae and Mycoplasma pneumoniae, a macrolide antibiotic such as azithromycin is the most appropriate choice to administer or give the patient. (Postma et al., 2015). For other severe cases which require hospitalization maybe due to bacterial pneumonia, parenteral antibiotics such as cefuroxime given 150 mg/kg/24hrs is given. Other antibiotics include cefotaxime or ceftriaxone.

            Age is one of the factors that affect the treatment effects on the medication that have been administered. Example, in the case of severe pneumonia where the patient has been hospitalized and parenteral antibiotics such as ceftriaxone is used, the dosage of the drug is greatly affected by age. Adults for example are prescribed 1-2 g every 24 hours while for children it is 50-70 mg/kg/day (not to exceed 2 g in a day) for every 12-24 hours. This medications need to be given with caution and only appropriate doses to reduce adverse reactions.

References

Rajpurkar, P., Irvin, J., Zhu, K., Yang, B., Mehta, H., Duan, T., ... & Lungren, M. P. (2017). Chexnet: Radiologist-level pneumonia detection on chest x-rays with deep learning. arXiv preprint arXiv:1711.05225.

Postma, D. F., Van Werkhoven, C. H., Van Elden, L. J., Thijsen, S. F., Hoepelman, A. I., Kluytmans, J. A., ... & Oosterheert, J. J. (2015). Antibiotic treatment strategies for community-acquired pneumonia in adults. New England Journal of Medicine, 372(14), 1312-1323.

Introduction

                Hippotherapy is a kind of treatment strategy where horse movements are made useful by individuals who are specially trained such as physical therapist, certified occupational therapists, and speech-language pathologist in order to manage various impairments and other defects with a primary aim achieving good functional outcomes.

History

            Hippotherapy started a long time ago and can be dated to 460-377 B.C where, a chapter on Natural Exercise included riding as one of them. The Hippocrates wrote this from ancient Greece. Horse riding was also mentioned in 1569 when an Italian Merkurialis wrote on The Art of Gymnastics. In the year 1780, a book Medical and Surgical Gymnastics which was written by Tissot from France described riding as one of beneficial gait. He also explained the effects that come as a result of riding for a very long period and its contraindications.

            During the 1952 Helsinki Olympics, the winner of a silver medal at that time, Liz Hartel, in equestrian sports, described how riding had facilitated her recovery from polio. Hippotherapeutic centers increased, and by 1960s it has spread throughout the United States, Canada, and even Europe as the horse riding was taken as part of physical therapy in other countries such as Germany, Austria, and Switzerland.

There was an establishment of the North American Riding for the Handicapped Association (NARHA) in the year 1969. It is a membership organization that promotes professionally safe and therapeutic equestrian activities taking care of ethical consideration by educating, doing research and communicating to people with disabilities. This organization was established in the United States. There was also development on treatment uses for the horse movement in 1970 by the physiotherapists in the United States. This progressed well until 1987 when a group of 18 individual decided to go to Germany to study hippotherapy, and there was a development of the standardized curriculum for hippotherapy. There was further development of the curriculum by the National hippotherapy Curriculum Development Committee between the years 1988 to 1992.

After the development of the curriculum, American Hippotherapy Association was formed in 1992, and it is a non-profit organization which is involved in the provision of education and also help to promote equine-assisted therapy that will significantly aid in improving the health of those individuals living with disabilities. It was later in the year 1993 approved as the first section of North American Riding for the Handicapped Association.

The American Hippotherapy Association later in 1994 set standard of practice, overseeing the curriculum, having the necessary training and skills and also ensuring that the therapists work according to the practice act. In 1999 there was also the establishment of the certification board and hippotherapy clinical specialist, and there was also the first examination for the hippotherapy clinical specialists.

In 2003, the American hippotherapy association (AHA) become independent, and the organization was incorporated in Florida and later in April 2007, it held its first conference in Atlanta. There were letters of support that the association received in 2011 and 2012 from AOTA and APTA respectively and later in 2016 the reimbursement committee was changed to standing committee from the task force. In the year 2017, there was a formation of a new committee to address the growing demand of the members; this involved ethics and advocacy and also marketing and social media.

In March 2017, there was adoption and release of the best practices and also a revision of terminologies. The use of hippotherapy in physiotherapy, occupational therapy, and speech-language pathology document was also released. Later in the year, the association received a letter of support from ASHA. The association then moved into new offices where all the work and all the activities are done in one place. This means that the organization equipment and all the staff members work in the same area.

Benefits of hippotherapy for the patient and the horse

 Hippotherapy is a therapeutic treatment which is performed by use of a horse and it has been found to have numerous benefits. It is used currently to engage the neuromotor, sensory and cognitive systems to achieve the functional needs. Riding in the back of the horse is very beneficial to those individuals who have disabilities as it helps in the pelvis and the trunk movements. This is because as the horse moves it triggers the movement of the body which in turn would have not even moved on the wheelchair. The changes thus produces exercises of the core muscle which is beneficial to the body.

As the horse also moves, there are movement repetitions and certain rhythm which can thus influence neuromuscular developments by triggering the mental and physical reactions. During the movement of the horse, there is action and reaction; this causes the changes of the trunks which requires one to remain upright. There are also numerous physical movements and sensory activities that take place during the movements of good respiratory control.

Hippotherapy is linked to promoting good respiration control, the series of movements that are made by the horse stimulates body activities which are then stimulate and affect the rate of respiration. With hippotherapy, it acts as an exercise, and thus the patient can be able to have good respiratory control in the long run. It also improves the postural symmetry of the individual and control of extremities as well as enhancing the strength of the patient trunk through the actions of muscle stimulation. Muscle stimulation improves the strength of the muscles and thus improving the patient trunk strength.

Hippotherapy also enhances the strength and balance of the patient, and this is because, during the movement of the horse, the patient has to maintain the gate and also the balance as the horse moves forward. With this, the patient will be used to movements and will adapt as they try to balance themselves. Learning from the horse also stimulates the patient to maintain balance on their own.

There are also other benefits such as enhancing endurance and improving the sensory input. The patient becomes used to the activities that usually, and the body also adopts due to the changes that generally occurs mentally, physically and psychologically as the hippotherapy is administered. The clients reduce fear maybe on riding the horse, the body muscle and the respirations has also adapted to the activities, all this promotes endurance and the sensory input

 The patient also benefits from enhanced response time as the patient becomes more active and the level of attention is also increased during the horse riding process. The whole activities including the physical control sensations need the active involvement of cognition, and thus this will be improved. The client might also be able to express his/her thought during the horse movements, therefore, befitting the patient cognition.

The patient understanding of visual cues are also improved; this occurs as the movement of the horse exposes the client to a wide range of activities and other things. The movements of the horse cause body change in the horses and also movements of the patient and thus he/she might be able to understand what is seen. This improves cognition.

Hippotherapy also improves the self-esteem of the client. This can happen the patient can maintain balance and generally being able to ride the horse. Hippotherapy is mainly for those who have disabilities and therefore, the ability to perform something they were unable to do during their past makes them proud and thus developing high self-esteem.

There is also an opportunity for social interaction because hippotherapy is like a social event and riding a horse is fun to most people. This will promote their social interaction with different people from those he/she is used to. This is primarily supported by improved self-esteem of the client as the clients also might enjoy interacting with the animal. The client will also be able to develop an interest in the treatments, and this is due to increased interaction and even understanding of all the treatment process.

Other benefits to the horse are the improvement of physical fitness through exercises in the field during the hippotherapy process. There are also different people who use the horse for hippotherapy. The horse health needs to be right before they are taken for hippotherapy and thus they benefit from frequent check-ups by a vet. The horses also have to be fit, and therefore, they are feed with proper diet. The horses are also groomed well which reduces incidences of injury and also they are able to socialize with other people in the field. This promotes their wellbeing.

Strongwater Farm is a therapeutic Equestrian center that aims in promoting the wellbeing of individuals by use of the horse. They provide emotional support, education and also social support, and this is done in the hippotherapy.

Difference between Health Impacts of Being Insured versus Being Uninsured Relative to Maternal Health Improvement

            Insured women have higher probability of receiving high-quantity and high-quality services compared to uninsured women. They are able to access information concerning the complications of pregnancy during the visits of prenatal healthcare (Gajate-Garrido & Ahiadeke, 2015). Urine and blood sample tests are taken for analysis to detect abnormalities that might later complicate and interfere with the pregnancy. Prompt management is carried out in order to protect the women and the babies in the womb from any danger. On the hand, uninsured women are unable to access the high-quality and high-quantity services easily because insurance cover is not available which would otherwise help them claim for better services similar to those of the insured. Being insured therefore enables one to access services involving early detection and prompt management of obstetric complications through access to high-quality and quantity services. This leads to better health status of the women and their babies relative to improvement of maternal health.

            Women who have been insured have greater chances of delivering in a health facility compared to those women who are not insured. The uninsured women also have the chances to get the health facility delivery, but the insured women have reduced cases of lacking access to health facility deliveries (Gajate-Garrido & Ahiadeke, 2015). This enables the women to access both preventive and curative care within the health facility. The women are able to gain more information concerning the importance of health facility delivery. It also enables the women to get familiar with the health facilities’ institutional features. This knowledge helps the women to become comfortable and confident with the health facilities. It also enhances proper care for the women and their babies during delivery because there is the accessibility of skilled-birth attendance. This results to good health conditions of the babies and the women which is an impact of improved maternal health.

Comparison of Health Outcomes Related to Improving Maternal Health in United States and Countries with Universal Health Coverage

            The united states have been able to adopt new strategies of preventing infections among the newborn babies who are at high risks. There is the application of good breastfeeding practice to enhance good health and prevent acquisition of infections by the newborn while the countries with universal health coverage has adopted the use of aseptic techniques to prevent the newborns from acquiring infections. Baby-Friendly Hospital Initiative in United States has impacted knowledge on women concerning early breastfeeding which leads to improved health of the new-born (Lauwers, & Swisher, 2015). Women are now in the position to know that breastfeeding is supposed to be initiated within the first hour and exclusive breastfeeding should be practiced for the first six months. Later, safe complementary feeds are supposed to be initiated and breastfeeding continued for at least two years. Contrary to this, improved maternal health has enhanced the usage of preventive measures which are helping in prevention of early childhood early infections. This has been achieved by applying aseptic technique practices during delivery including use of clean kits for delivery and proper care of the cord. This is a different strategy from the one which is applied by the United States. This practice has lead to reduced cases of childhood mortality among the population of the countries with universal health coverage.

            Improved maternal health care has reduced the maternal mortality rates in the United States. The clinics are currently being in the position of providing branded family planning and maternal healthcare services and the services being offered have been upgraded increasing the number of patients going to seek medical help. In the year 2003, the number of childhood deaths among children 1-4 years of age was 31 per 100,000 (Ricci & Kyle, 2009). On the other hand, there has been decreased mortality rate in a country with universal health coverage but contrast to united states, research is showing the rates of maternal mortality is still high regardless of the much efforts to bring this rate down. A country with universal health coverage like Bangladesh, he mortality rate was 32 per 1000 live births in the year 2013 (lessons in sustainable development from bangladesh and india, 2018). These data is showing that the maternal deaths are still high in countries with universal health coverage than in the United States. The rate of deaths among children is still relatively high bearing in mind that there is still a difference in years and more strategies are being put in place to enhance the improvement of maternal health in the United States thus the mortality rate in united states is highly declining compared to that of a country with universal health coverage.

Reference

 Devakumar, D., Hall, J., Lawn, J., & Qureshi, Z. (Eds.). (2019). Oxford Textbook of Global

            Health of Women, Newborns, Children, and Adolescents. Oxford University Press, USA.

Gajate-Garrido, G., & Ahiadeke, C. (2015). The effect of insurance enrollment on maternal and   child health care utilization: The case of Ghana (Vol. 1495). Intl Food   Policy Res Inst.          

Lauwers, J., & Swisher, A. (2015). Counseling the nursing mother. Jones & Bartlett Publishers.  

Lessons in sustainable development from bangladesh and india. (2018). Place of publication not identified: PALGRAVE PIVOT.

Ricci, S. S., & Kyle, T. (2009). Maternity and pediatric nursing. Philadelphia: Lippincott Williams &                Wilkins.

Best Company to Work For

            OhioHealth is the best choice of the company I would wish to work for. It is ranked as number 99 in the list provided by the fortune 100 best companies to work for. The one thing that comes in the mind when you think of OhioHealth is quality healthcare they offer to the customers and that’s actually there mission. In all the areas they provide health, the mission is never abandoned. They also provide the best experience whether you are an employee or the patient.

            The fact that it is non-profit company means that it is not driven by profit and thus they focus on provision of the best care delivery. That is care of high quality, convenient and care that is timely to all the clients. As long as they provide the best care and promote good health to the clients that is all they want.

            They offer a wide variety of services including cancer care, care for patients with diabetes, electronic intensive care unit, emergency and trauma, lab services and even rehabilitation. There are so much more. That simply means that you cannot be ever disappointed to tell a client that we do not offer that services. Client satisfaction is very important because it also makes you as the care giver feel good.

            In the company, precautions have always been taken to protect all the people working or getting services from exposures that may cause health issues. For example, tobacco is not allowed and also all the equipment and supplies such as the personal protective equipment are always available to foster service delivery. They also offer health insurance to their employees and other health benefits which thus promoting good health for them.

            The working area is also safe all the time because there are security officers who have been assigned duties all the times. In this facility also, firearms are not allowed including any weapons and therefore, safety of the workers and the patients are well taken care off. Furthermore, all the patients in the wear armband which are of different colors depending on the medical risk that the client have. This makes it easy for the caregivers to easily identify patients and thus making it easy and minimize chances of confusions and also facilitating easy identification to allow for proper monitoring and care delivery.

            In this company provision of care is completely collaborative, they have also volunteer’s services for individuals who might want to give back to the society. This drive of providing care together makes the experience of care delivery to other individuals more important to you, this actually provides motivation because the impact can be seen.

            The health facility also promotes career development because they encourage their workers to share their knowledge and through this, they are able to learn and grow their careers which can even enable them develop skills to lead. It has all the necessary tools and also the best environment which is completely friendly to help you develop yourself personally and professionally.

            Apart from the normal work that is done throughout, there are also some challenges that the employees are exposed to, Care is continuous and thus, the challenges have to be overcome. This will enable the workers to be innovative and explore their careers. All this are rewarded and thus act as a motivation to explore the potential that you have.

            OhioHealth also provides time away benefits to their employees and also flexible schedules. This promotes good understanding to the employees and also will encourage one to work in the facility without feeling oppressed. This shows that the company the needs to balance work and life itself which is a benefit to the employee.

References

OhioHealth (2019) retrieved from http://www.ohiohealth.com/careers/why-work-here

The public health issue or global health challenge

            The intricate connection between male and female, well-being, progress , social and economic status, implies that men and women’s susceptibilities to HIV/AIDS is a subject in need of addressing, not only in the medical sector but also in other departments of the society (HIV/AIDS and Gender: Fact Sheet).

 In sub-Saharan Africa, HIV infects an estimated 1000 infants per day in spite of the accessible health measures. Pediatric HIV is one of the main factors contributing to the spread of HIV among newborns all over the world (HIV/AIDS and Gender: Fact Sheet).

 Magnitude of the challenge

 The occurrence of HIV persists among young fertile women especially in the Sub-Saharan region. In early 2007, HIV infection among pregnant women present at gynecological clinics stood at 20% in Sub-Saharan regions (HIV/AIDS and Gender: Fact Sheet).. In the absence of precautionary interventions, the entire rate of mother to child infection of HIV in breastfeeding may be a staggering 25-45%. Before, scientists stumbled upon antiretroviral measures meant to avert mother to child transmission, of HIV among Sub-Saharan women, innovative studies determined the extent of the challenge, the effect of the HIV epidemic and the risk factors linked to mother to child transmission.

 Health consequences

Infants born to females with HIV infection get HIV drugs for 4-6 weeks after birth. Antiretroviral drugs reduce the amount of HIV infection in the blood stream of the baby hence insulating the baby from the effects of HIV consequently stopping from graduating into AIDS (A Student’s Guide to Writing a Global Health Policy Brief). Since HIV can pass through the breastmilk, baby formula is the best way of feeding and the best substitute for breast milk (USAID Syria Complex Emergency Fact Sheet). In addition, risk factors such as a great viral load, low CD4 amount or the presence of AIDS related infections.

Reference

Fact Sheet.PDF

USAID Syria Complex Emergency Fact Sheet.pdf

 World Bank Basic information Fact Sheet.PDF

HIV/AIDS and Gender: Fact Sheet Overview.PDF

 A Student’s Guide to Writing a Global Health Policy Brief.PDF

1. 1. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree

to 80% by 2020.

             I believe that there is a need to increase the number of nurses who have a baccalaureate degree. This is due to the current growth in demand for complex care requires higher qualifications of the nurses (Cherry & Jacob, 2016). It is true that most of the nurses who were trained some years back focused mainly on managing some injuries and also acute conditions.

However, there has been a shift, and most of the health condition that is currently affecting most people are conditions such as hypertension, mental health conditions, diabetes, conditions of the heart and even arthritis. This condition needs complex management. Therefore, there is a need to improve the proportion to ensure that the care delivered to the individual is of good quality.

As a nurse I want to deliver the best and care of high quality to my clients and therefore having a bachelor degree will give me a chance. This is because, it provides the necessary competencies to facilitate high-quality care delivery (Cherry & Jacob, 2016). It also focuses on research, use of evidence-based practice and teamwork and collaborations. This will surely promote the best care delivery and management of the conditions, and I firmly believe I can fit in.

2. Recommendation 5: Double the number of nurses with a doctorate by 2020.

This is another recommendation that I find it very appropriate. Increase in the number of nurses with a doctorate will enable the health care to have more staff, who will be able to carry out researches and establishment of a faculty position. The outcome of the study which are done mainly by the nurses with this level of education will enable the nurses to come up with recommendations of intervention which will facilitate adequate and quality delivery of care to the clients. It is also essential to have enough number of staff to have better outcomes and to promote timely delivery and filling the gap that may cause limitations in finding quality care intervention and also the removal of interventions that are not helpful to the patient. I find it necessary to have the number doubled.

3. Recommendation 6: Ensure that nurses engage in lifelong learning.

With the current intention to deliver quality care to the clients, there is also a need to develop skills to fit the changes which occur continuously in the care delivery. I think it is necessary for the nursing education to understand these changes, and give the nurses the opportunity to transition to higher degree programs. This will surely provide nurses with the knowledge they need to take care of the client and also be in a better position to give competent nursing diagnoses which will promote better client management (Presti, 2016). Lifelong learning will improve the individual competency in delivery of care, and I can doubt that.

4. How will increasing your level of education affect how you compete in the current

job market?

            The current demand in health care, calls for high-quality delivery of care which has become more complex. Having the best level of education increases the opportunity to secure a job because the hospitals and other medical practices look for highly-qualified candidates which means you need to have a good education, and other characteristics such as level of experience (Auerbach, Buerhaus & Staiger, 2015). It also increases the knowledge base concerning better management of various condition which is a qualification.

5. How will increasing your level of education affect your role in the future of nursing?

With an increase in the education levels, there will be more opportunities as different roles come in. Increasing the level of education will enable me to move to different programs and even to the doctorate level which will undoubtedly allow me to fit in the future of nursing. There are also increased ability to perform various activities such as carrying out researches and even some leadership roles

References

Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2015). Do associate degree registered nurses fare differently in the nurse labor market compared to baccalaureate-prepared RNs?. Nursing Economics, 33(1), 8-14.

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Presti, C. R. (2016). The flipped learning approach in nursing education: A literature review. Journal of Nursing Education, 55(5), 252-257.

                                                             Question 1

            According to the modern research, evidence-based practices have been perceived as being one of the best means that can been utilized for the purpose of enhancing health care delivery, cost reduction, patient and family satisfaction, and professional development. The reason for that is because it has been realized that organizational and individual barriers are the main obstacles that has the ability of hampering the implementation of these practices that can in return be harmful to healthcare provision (Herbert, 2009). 

            As much as endotracheal suctioning practices of nurses is concerned, the main objective of its management authority entails ensuring that they have some of the organizational and individual barriers that have the potential of impacting the utilization of EBP. In order to be in the position of understanding the impacts that this has to an healthcare organization and its stakeholders, it is important to take into account   individual perceptions, the absence of familiarity with this protocol, the general lack of access to data required for EBP, personal decisions, the presence of insufficient information, resistance to change, and so on. 

            Taking into account the importance of the critical appraisals skill program (CASP), the truth is that some of the perceived clinical barriers are ultimately associated with the various means that are used for the purpose of supporting healthcare operations.  This implies that in order to be in the position of enhancing the equitable delivery of healthcare in any department, it is important for physicians to ensure that they have recognized organizational and individual barriers that has the potential of hampering the implementation of RNs and RTTs (Rosanne, 2019).

                                                            Question 2

            The general absence of adequate information is one of the factors that have been medically identified as being one of the ways that compels clinicians to change their health care ways. The reason for that is because; the majority of healthcare organizations do not have standardized clinical implementation strategies that are more effective in transforming research findings. With endotracheal suctioning practices of nurses, it means that world health care organizations should have the ability of indentifying effective means that can be used for the purpose of reducing existing barriers. The reason for that is because they are the ones that have the potential of minimizing the obstacles of evidence practice gaps (Rosanne, 2019).

            On the hand, the enablers and the barrier of EBP are some of the clinical factors that have the ability of determining healthcare practices that has the ability of facilitating or preventing therapeutic improvement. Due to the fact that such barriers can exist in multiple levels, the truth is that some clinical guidelines needs to be identified as one of the resourceful means of assisting physicians, patients, and their families to come to a clear conclusion regarding their health care requirements. The same reasoning is the one that has the potential of indentifying some of the available medical interventions that can be tailored or generalized for improving the services of their organization (Herbert, 2009). 

            Consequently, some of the procedures that are used by the intensive care mainly take into account the suctioning of individual’s secretions. Regardless of that, the general absence of clarity concerning the RNs and RRTs practices is the one that contributes to unsafe and inappropriate clinical procedures. The end result of that is that it minimizes health care outcomes as well as increasing the likelihood of receiving poor patient outcomes (Rosanne, 2019). Therefore, it is important for physicians to understand the side effects of these procedures.

                                                            References

Herbert, R. (2009). Practical evidence-based physiotherapy. Edinburgh: Elsevier Butterworth Heinemann.

Rosanne Leddy, J. (2019). Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines?. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530836/ [Accessed 14 Mar. 2019].

Abstract

 The purpose of this research paper is to review the topic on ‘end-of-life option' using different perspectives including ethical perspective, cultural perspective, scientific perspective,   and analytical perspective.  Since the end-of-life option is a controversial issue, these perspectives will help conduct an in-depth analysis and understand whether terminally ill patients and physicians should use the end-of-life option without legal liability. The hypothesis of this research is that terminally ill patients should be permitted to make medical decisions and in specific, end-of-life option.  In the introduction, the paper introduces the end-of-life option act which states that all adults with terminal illnesses have the right to request the aid-in-dying drug.  The paper provides a specific perspective that provides a supportive argument and a mechanism on how the patients die. The paper provides an analytic perspective to provide the data and information regarding the health spending for terminally ill patients and how the end-of-life option has brought a great improvement in the number of stay in hospital patients.  According to the ethical perspective, the  idea of  end-of-life option is a two-edge-sword since  supporters argue that  terminally patients should  be aided  to die to eliminate financial  hardships, pain and suffering and emotion  suffering  to the family members. However, opponents argue that assisted suicide will become a norm in the palliative care and any patient who suffer from medical finances would be given this option of which is unethical. Finally, the cultural perspective incorporates religious views to argue that people should die with respect and no one has the right to interfere with the nature life expect God.  The paper derived data and information from journal article to provide a credible evidence and a compelling conclusion.

Introduction

            End of Life Option Act refers to a new California law which will agree a terminally sick patient present a request for a drug from his own physician which will eventually terminate the patient's life. Different patients who do request to end their own life this manner and those who critically follow the set steps of law are not considered to have committed suicide as the act is considered lawfully in California. Physicians who provide help for their patients in this process with a care provider and follow up of the needed steps in the law will be providing a new improved and legal form of an end of life care and hence will not be a subject on the legal professional or liability sanction in doing so. Within the state, there are different types of people who can use this type of Act. To get this aid-in-dying, the patient must have attained the age of 18 years and above and also must be a patient and a resident within the state of California (Forbes et al., 2017). In addition to this, the patient must also have the terminal disease in him, the patient should also have the capacity to make very sound decisions, should not have impaired decisions as a result of being mentally disordered and lastly should have the mental, ability and physically fit to take the drug at the time the physicians want to apply it. In addition to this, patients within this state cannot request aid-in-dying in other documents or advanced directives.

            Culture basically shapes the manner in which people view illness, misery, and dying. With the ever-increasing diversity all over the world, especially in America, multicultural interactions between patients and medical caregivers of various backgrounds are becoming common phenomena (Aramesh, & Shadi, 2007). As a result, the risk for multicultural misinterpretation concerning health upkeep at the end of life is on the rise. Researches revealed existing variances in approaches toward truth telling, life lengthening technology and decision-making mechanisms at the end of life. This paper will carry out an in-depth analysis on both ethical and cultural perspectives on underlying reasons Muslim culture and religion do not permit end of life option. In addition, the essay will single out power, finances, and control matters surrounding the termination of life or euthanasia and all other aspects surrounding the topic.

Scientific Perspective

            Euthanasia in patients is done by the performing and attending physician through administering a fatal dose of a suitable drug the patient in need on the drug on his express request to be done so. The connected Dutch legislation likewise covers the physician-assisted suicide this happens in a case where the physician suppliers the drug but the patient personally administers the drug himself. In addition to this, Palliative sedation is not a type of euthanasia but the suffering patient is just rendered unconscious with drugs which reduce pain on the patient where the patient dies eventually from just a natural cause. According to the law of land, assisted suicide and euthanasia are legal actions if the method laid down in Termination of life act on assisted and request suicide actions are completely and fully followed.

            There are greater significant which are connected with euthanasia in human beings for it helps patients with the terminal to end their life's and hence end the sought of suffering which they go through after they get sick. To apply these drugs to patients, different methods can be used to apply these drugs to patients. These methods include the application of different drugs to the patient which includes a doctor prescribing a type of drug which is indent at killing the patient. After the drug is prescribed by the doctor, the patient is made aware of the directions which make the patient understand the process of taking the pills. The other method which can be applied is the for injection which includes the application of an injection to a patient which is aimed at rendering a patient comatose which is followed by another injection used to stop the patient heart from functioning, Dehydration and Starvation which make the right-to-die different activist mostly advocate the critical withdrawal of water and food in order to hasten death to the patient (Taylor, 2017). In addition to this, plastic bags, gases and peaceful pills is another method referred to as self-deliverance which in common methods advocated by the right to die activists. The above highlights just the different methods which can be put in practice for the application of euthanasia on patients and which applied can critically perform the practice bet of patients. A critically fall up and application of the above methods makes the process important.

            After the patient is confirmed for the activity, the practices involve injecting the patient with one type or more types of drugs into the person for the purpose of expressing or causing direct death to the patient. After the drug is applied to the patient, it causes the patient to get unconscious where different body parts get their operational rates of work within the body happening slowly hence the patient goes unconscious. After going unconscious, the patient stops breathing which leads to heart arrhythmia in that order followed by the brain where the patients eventually die from the effects of the applied drug(s). 

Mathematical/Analytical Perspective

            As the use and application of end-of-life Act in California state have been passed and its effects felt, people have continued to use the method in terminating persons life’s who have a terminable disease. The act has proved to be effective hence people have continued to apply this method in terminating lives. The number of people who have been applying this method for their loved ones has increased drastically since the policy was passed. For example, CNN reported that one-hundred and eleven people who died last year have all died through the application of this process. When the End of Life Act went on effect on 9^th June 2016, it gave Californian residents who were of 18 years of age and above the mandate to request a sought of life ending request from different medical health doctors if they are called suffering from a terminal type of illness (Taylor, 2017). As reported, in 2016 between June and December, 258 people initiated and applied the procedures associated with the process where 119 people were then prescribed for lethal medication. As a result of the medicine application, 111 of the people of whom the drug was applied to die from the effects of the drug, 21 persons died as result of the underlying terminal illness where the results of the other 59 people who were prescribed for the drug is currently unexplained and there has been no reported result within the time frame. It is claimed that of the 111 people who utilized this treatment were cancer patients with a median age of 73 years of age where most of them were whites.

            As presented the total health care spending for people in America was reported to be around $3.5 trillion in the year 2017 where 32% of the total amount was reported to be used on medical health care only. Hospital cost in the nation averaged around $3,949 per day where each person stays in the hospital was estimated to be around $15,534 (Quill, Back & Block, 2016). These figures have recently dropped as a result of End-of-Life-Act introduction. Most of the people who used to stay in Hospitals for longer periods of time have recently been here living terminated hence indicating a drop on those figures.

            Cultural perspective

Passing away with dignity regulations permit a terminally ill patient to accelerate an unavoidable death (Brockopp, 2008). While many faith customs observe ancient customs and insights concerning the final steps before one’s life come to an end, advancement in technology made it possible for religious people to reexamine some philosophies. Death and dignity laws give people a chance to contemplate a vital question pertaining their life.

 Muslims are against euthanasia or aided death. Muslims believe that all human life is holy and comes from God or Allah and Allah is the only person who has the right to take or preserve life. Mortal beings have no right to interrupt the natural course of life. Hence ending life is a not an option for Muslims and prohibited among members. Medical doctors should not take an active role in the termination of a patient’s life (Naseh, Rafiei, & Heidari, 2015). According to the Qur’an, no person has the right to take another individual’s life except while seeking justice.

 Just like any other religion, death is a vital aspect of Muslim religion. Strict Muslim believers do not support resuscitation as they claim it is a form of euthanasia, strictly prohibited within Muslim circles (Lippert et.al, 2010). A Muslim cannot commit murder or take part in it in any way. In addition, Islamic code governing ethics maintains that even if a person is in a vegetative state, the role of a medical doctor is maintaining or sustaining life.

Accepting the end of life option shakes down the sacredness of life according to most Muslims. End of life option has a pendulum effect on critical communal issues such as whether a fetus during its early stages is an actual being. As absurd as it may seem, a patient with a terminal illness has a right to life and completely human. The sacredness of human life does not stem from religious perspectives or opinion but the need to value life, regardless of the medical state in which it exists (Moss et.al, 2010). Advocates of euthanasia suggest that life is priceless but also bring forth another flipside of the argument. Ending the life an individual suffering from a painful sickness, brings respect to human life. Dying with respect sanctifies life. Thus, the contentious issues revolving around end of life option continue to evoke endless debates and sometimes the advocates cross the line. However, it is vital to note that quality of life has no connection with sanctity. Consequently, between quality and sanctity, the sacredness of life outweighs the quality of life. Viewing the argument in terms of quality of life, it actually implies that people with a low-quality lifestyle deserve to die. Maintaining the same line of thought means that individuals with a quality life have more right to live than their counterpart does. In short, Muslims scholars support their argument from all angles: legalistic, social, and religious angles.

Ethical perspective

For instance, the right to sell oneself to slavery is not a well-thought-out action. Neither is the right to end your own life due to the scourging effects of a terminal illness. A physician in a resource limited medical facility, the insurance institution, emotionally drained relatives attached to the patient may find the option of ending attractive once it becomes a viable option tabled in front of them (Yousuf, & Fauzi, 2012). Therefore, removing the option of death, gives medical experts and insurance institutions the right to fight against terminal illness and find creative ways of preserving the will of life.

Of course, the other side of the argument might claim there are better ways of going about euthanasia. For example, some people may suggest that psychiatrists and doctors might assess a patient and confirm whether the person is of sound mind before acting upon their decision (Lippert et.al, 2010). Nevertheless, the above context applies only to people with a terminal illness or others who want to end life. Although their reasons seem valid, they are not justifiable to the humanity and society. Therefore, no one has power to give a go ahead for the procedure used in the elimination. Thus, assisted suicide would open an entire Pandora box of controversies if the government allows pain and suffering to be the main determinants of euthanasia. Once voluntary assisted suicide becomes normal, it would spread to palliative care patients. Any tom dick and harry would request the procedure once medical finances dwindle.

 Proponents of ending life option may propose that the practice already exists in many various forms and doctors and other healthcare providers conduct it all the time without fear and that the media has no clue (Moss et.al, 2010). More so, legalizing it would open more secure ways for practicing the deed. Thus, accepting the procedure is likely to prevent its misuse and corruptions that often accompanies it. In other words, legalizing euthanasia would avail guidelines and prevent misuse of the procedure.

People have a right to live their lives as they please. There are many public attitudes toward end of life option (Naseh, Rafiei, & Heidari, 2015). Surveys show that there is not enough support for end of life option. Literature reviews on the topic show that more than two third of American do not support both euthanasia and regulations that accompany the procedure. Politically speaking, legislators hesitate on the issue because they might lose votes.

 Surveys that monitor trends speculate that physicians do not easily accept a patient’s plea for termination of life. In addition, there is a rising concern that people might exploit the poor and the old if end of life option becomes legal (Brockopp, 2008). Poverty stricken people may see death as an option when faced with heavy medical bills. Religion plays a major role in shaping the thoughts of people on the issue. In a country like India, where 90% of the population is Indian, the dominant faiths are Hindu and Islam. Hence, end of life option faces a stiff opposition due to the religious beliefs.

Two tactics inhibit the legalization of end of life option. The first line of thought seems to derive its main argument from a religious perspective which claims that people are made by God and their value is priceless and no one should interfere with the sacredness that comes from life. Thus, end of life option goes against personal dignity of life. With religion comes the ethical side of end of life option, which makes physicians take a stand against it. On the other hand, the rhetorical nature of the subject matter tends to excite and elicit emotions rather solve the underlying issue (Brockopp, 2008). For instance, let us consider a context where one withholds treatment from a person suffering from a terminal illness, when the treatment does not make a difference and the treatment itself has a negative toll on the patient, the context is a weighty matter but euthanasia is weightier. Another subtle element is discernment. A terminally ill individual does not have the ability to make sound decisions. In summary, legalizing termination of life stands on shaky ground and may be a go-ahead button that would permit myriad of crimes. More so, regulating the act is a tedious task.

Conclusion

             The research paper has reviewed the California end-of-life option act and different perspectives have offered supportive arguments and counterclaims regarding the issue.  From the Islamic point of view, life is a gift from Allah and no one should cause harm to his life or the life of others. The Muslim religion also acknowledges that Muslims should seek treatment from Allah.  In the case of terminally ill patients, physicians should give the patients and the family a realistic and achievable hope waiting for a natural death. Thus, the Muslim perceive reject the assisted suicide and argue that terminally ill people should be given quality care and pray to Allah to give them life.  However, focusing on other reasons and evidence, physician-assisted death should be legalized and the health care system should focus on ethical and social implication. It should also focus on the ethical perspective, analytical perspective, and scientific perspective. From the ethical perspective, the solution to the debatable issue of end-of-life option is that legalizing physician assisted suicide is an ethical act. This because, patients have the right to medical treatment and in this case, they have a right to request physician-assisted suicide. On the same note, physicians should fulfill the best interest of the patient as long as they are maximizing benefits and minimizing risks.  Second, it is ethical to provide physician-assisted suicide to promote justice.  In this case, justice means that there should be no conflict of interest but instead, physicians should provide medical care in the best interest of the care receiver.  By so doing, they alleviate patients suffering, they show compassion and respect to the choice of the patient and they promote emotional well-being to the family members. The analytical perspective concludes that physical-assisted suicide should be legalized to reduce the number of patients with terminal illnesses. Note that the patients and their family members also develop depression and anxiety due to hopelessness, financial hardships, and other concerns. Rather than allowing patients to continue suffering, physicians should apply the different easy methods to perform the practice.

Point to the future

End-of-life option or physician-assisted suicide is the solution to terminally ill patients.  Focusing on ethical, analytic and scientific perspective, this practice is effective in alleviating not only pain and suffering but also emotional and financial strains to the family members. Thus, it is ethically, clinically and scientifically right to end the life of terminally ill patients. Although the act is a statutory offense in some States, I believe that it is important to focus on social justices issues. In this case, the medical professional should focus on building human dignity by helping the most vulnerable people who view themselves as burdensome to their families.  In my opinion, I believe that nurses have an important role to play especially in the palliative care setting.  States that have not authorized physician-assisted suicide should do so and give the physicians the authority to terminate the life of critically ill patients. They should provide both active and passive euthanasia. I think that the use of medication when there is an inevitability of death is useless. At this point, the physician and patients should make a collective decision and prefer the end-of-life option.

Reference

Aramesh, K., & Shadi, H. (2007). Euthanasia: an Islamic ethical perspective.

Brockopp, J. E. (2008). Islam and bioethics: Beyond abortion and euthanasia. Journal of Religious Ethics, 36(1), 3-12.

Forbes, L., Petrillo, L., Dzeng, E., Harrison, K. L., Scribner, B., & Koenig, B. (2017).       RESPONDING TO             THE END-OF-LIFE OPTION ACT IN CALIFORNIA. Innovation in ageing, 1(Suppl 1), 505.

Lippert, F. K., Raffay, V., Georgiou, M., Steen, P. A., & Bossaert, L. (2010). European Resuscitation Council Guidelines for Resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation, 81(10), 1445.

Moss, A. H., Lunney, J. R., Culp, S., Auber, M., Kurian, S., Rogers, J., ... & Abraham, J. (2010). Prognostic significance of the “surprise” question in cancer patients. Journal of palliative medicine, 13(7), 837-840.

Naseh, L., Rafiei, H., & Heidari, M. (2015). Nurses' attitudes towards euthanasia: a cross-sectional study in Iran. International journal of palliative nursing, 21(1), 43-48.

Nelson, C. (2016). An Ethics of Permission: A Response to the California End of Life Option      Act. The Permanente Journal, 20(4),122.

Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to patients requesting physician-      assisted death: physician involvement at the very end of life. Jama, 315(3), pp.245-246.

Taylor, C. L. (2017). Veterinary hospice: a compassionate option at the end of a pet's life?. The    Veterinary Nurse, 8(8), pp.416-423.

Yousuf, R. M., & Fauzi, A. R. (2012). Euthanasia and Physician-Assisted Suicide: A Review from Islamic Point of View. International Medical Journal Malaysia, 11(1).

Abstract

This essay endeavors to review current information on immune responses to inoculations correlating with protection. Even though the human immune system is laid off, nearly all existing vaccines function via antibodies within serum that hinder contamination hence triggering protection. The practical features of antibodies as well as quantity are vital components aiding vaccines. Antibodies play a protection role, that is, a synergistic function. Immune memory is a vital correlate, which engages effector memory consequently leading to both short and long incubation of diseases. Cellular immunity destroys or overpowers intracellular diseases while at the same time synergizing with antibodies. Simply put, by looking into immune responses to vaccines, the paper answers the research question.

 Introduction

While vaccination against chickenpox took place an estimated 2000 years ago, in Asia regions, British medical doctors usually, credited with introducing the contemporary notions of vaccination (Castle et.al, 2012). In the year 1976, Edward Jenner utilized material derived from cowpox pustules to generate vaccines against smallpox. After the success of Edward, medical experts developed vaccines for various diseases such as measles and tetanus. Therefore, it is an easy task outlining the characteristics of an effective vaccine but few inoculations have an effective approach. In fact, inoculations do not exist for numerous organisms and scientists must look into the underlying reasons for such as phenomena. This paper evaluates the manner in which vaccines work.

How vaccines work

Vaccines boost the human immune systems against future attacks by specific diseases. There are various inoculations against virus-related and infectious pathogens. When a pathogen, gets into the human body, an individual’s immune systems produces antibodies, which give the body a fighting chance against the harmful pathogens (Castle et.al, 2012). Depending on the status of the immune system, and the effectiveness of the antibodies to fight the foreign harmful bacteria, one might either fall sick or not fall ill at all.

 Vaccines function because of the ability of the immune system to respond promptly to pathogens through secretion of antibodies. In addition, vaccines usually generated from killed, mild pathogens (Wang et.al, 2016). When one gets an inoculation, the pathogen within the vaccine is not resilient enough to cause illness but its presence is sufficient enough to trigger production of antibodies by the immune system. Consequently, one gains future immunity against the illness without falling ill.

Some of the vaccines, designed to fight off harmful bacteria with the same type of bacteria. In most cases, medical experts equip vaccines with altered types of pathogens produced from different microorganisms. For examples, Tetanus does not directly come from Clostridium tetani pathogen. Instead, its signs emerge principally from tetanospasmin, a pollutant produced by that particular bacterium (Smith et.al, 2011). Therefore, some microbial vaccines come from the same mild version of the bacteria that causes the symptoms to arise. The mild version of bacteria, also known toxoid hence a Tetanus vaccines comes from tetanospasmin toxoid.

Ethical issues and perspectives

 Presently, existing vaccines manage viruses by inducing antibodies. Still, there is room for further perfection or upgrade. For instance, the subunit that deals with influenza vaccine, offered In America comprises no adjuvant according to the producers. One could expect influenza infection to have an adjuvant vaccines that prompt production IgA and IgG2a responses (Nyhan et.al, 2014). However, efforts to come up with such a vaccine are underway. No matters the flaws, inoculation remains to be the main way for minimizing the problem of infectious illnesses and protect the health of the public. It is good to note that vaccines are compulsory in most nations and suggested in other countries, hence administrators control them in a paternalistic method. Furthermore, the public and inoculation recipients have a right to make an informed decision before accepting administration. The current humanity exists in a ‘post trust’ era environment, which implies that the general community does not put complete trust in regulatory bodies hence the need to question everything including the safety of vaccines accessible to the public domain. Consequently, the voice of both the medical expert and the people is heard. Information distributed through various channels such as social media need verification in order to clarify on accuracy before dissemination and interpretation.

The public recognizes threats differently from medical practitioners and these variances may contribute to an increase in vaccine indecision. Health institutions should ensure effective communication strategies that enhance trust among members of the public (Larson et.al, 2011). This is inclusive of cultivating listening procedures, gaining insight on how other individuals perceive or evaluate risk and then use the mechanism to make better decisions. In short, it is ethical when both voices are heard and the manufacturers cast out all the doubt.

Vaccination and the Main Types of Vaccines

Vaccination is the general administration of antigenic substance in the stimulation of a person’s immune system with the intention of developing adaptive immunity against the existence of pathogens. Thus, vaccination is the use of vaccines as treatment to develop immunity against certain illnesses (Larson et.al, 2011). Vaccines have the ability to preventing the acceleration of infectious illnesses. When a large portion of the populace is vaccinated then mass immunity is the result. Vaccination is used to build immunity against severe and threatening diseases such as Polio. History began with smallpox, a popular virus that is common among young children and leads to the development of painful blisters all over the body. There are several types of vaccines such as inactivated, subunit and Toxoid vaccine. There higher the similarity amid the illness and the vaccine the better the immunity response.

Inactivated vaccine is the option to weakened vaccines. Such vaccines are developed through the inactivation of the existing pathogen, through the utilization of chemicals. The vaccines normally destroy the general capability of the pathogens to duplicate but maintains it at a favorable state to enable better recognition by the immune system (Castle et.al, 2012). The inactivated aspect is used to refer to the epidemiologic vaccines of such kinds since the viruses are considered not alive. Inactivated vaccines are used today in the vaccination of illnesses such as polio and Hepatitis A.

On the other hand, Toxoids vaccines are commonly used in vaccinating against the dominance of bacterial illnesses do not result from bacterium but are caused by a toxin that leads in the bacterium (Castle et.al, 2012). One of the leading examples of these vaccines is tetanus where Tetani bacteria do not generate the resulting symptoms but the neurotoxin it makes. The immunization process for the existing pathogen is resolved through the inactivation that leads to the illness. The immunization using toxoids in American and across the world is most common for diseases such as diphtheria, and tetanus.

Subunit and conjugate vaccines usually contain the composition of pathogens that they guard against. Thus, they are categorized to be the most effective since the vaccines are similar to the pathogens (Nyhan et.al, 2014). Subunit vaccines normally utilizes just a section of the targeted pathogen which is intended at triggering a more effective response from the general immune system. The general process can be achieved through the isolation of a given protein that differs from the general pathogen thus developing it as a major antigen personally. Influenza vaccines represent one of the most common sample of subunit vaccine. The vaccination is intended at providing immunization against illnesses in general. Conjugate vaccines offer similar vaccination to recombinant which fights against all the existing pathogens and bacteria. Pneumonia and Hepatitis B are also treated with subunit vaccinations.

When one thinks of vaccination, administration by a doctor comes to mind. In view of the future, immunization methodologies are likely to change. For instance, inhaling vaccines is one of the new method of vaccine administration in cases such as influenza. To illustrate further, nasal sprays built to administer respiratory medicines (Turnock, 2012) .Secondly, patch administration technique is more likely to take the place of syringes and oral vaccinations in the near future. In this methodology, a patch designed with highly microscopic needles administers a vaccine when it comes into contact with an intended recipient. Of course, the delivery methods become more mobile and simplified. However, medical professional are still vital. Apart from simplifying delivery method, future storage wills change. The reason eradication of smallpox was possible relied entirely on flexible storage of medicine. Experts are developing ways that can store vaccines in more relative temperatures to accommodate and prolong usage of the vaccines in more diverse environments. In fact, extending the shelf life of vaccines gives   will be more cost effective and efficient in the future. Thus, the future looks to upgrade the delivery methods and storage methods that in turn will make it more cost effective to the people in need of the vaccines.

In general, inactivated vaccines utilizes the killed version for germs that leads to illnesses. The inactivated vaccines normally leads to protection and enhancing the immunity for the body that leads to strength (Turnock, 2012). In such cases the inactivate vaccines must be taken in several doses over a stipulated time period such as that of polio so that a continuous and long run immunity against the illness can be achieved. On the other hand toxoids vaccines utilizes a germ that leads to the development of an illness to fight the disease. The immunization seeks to create stronger germs against the existing germ, which leads to immunity.

 Roles of Vaccinations

Immunization helps prevent or mitigate child immortality among infants. Protection commences before the mother gives birth. An expectant mother needs to under vaccination against sicknesses such as influenza (Smith et.al, 2011). During pregnancy, these diseases can also affect the child through the placenta that is in contact with the mother’s blood stream. Therefore, vaccinations act as a buffer for the mother and the unborn child. After immunization, breastfeeding a child from birth makes the infant healthier as the milk remains free from any form of contamination. Furthermore, after birthing an infant, the infant goes through a series of immunization programs that helps save the child from prevalent health complications and upgrade the quality of life of the child.

Vaccines and public health

Public health researchers are concentrating on vaccination studies as they try to find a breakout in other areas such as diabetes (Wang et.al, 2016). Attempts made to gain insight and find cure for diseases have some unintentional outcomes of the newly advancing techniques. The study of epidemiology came as a result of trying to stop the spread of cholera in England. In addition, other than diseases, other factors or forces have come into place to enable effective use of vaccines.

There is the limited number of illnesses that have had out of balance effect on the history of the vaccination. These include disease such as smallpox, tuberculosis, and HIV/AIDS among others. The first two diseases have existed for many centuries hence the development of effective immunization; HIV/AIDS is a contemporary predicament and no vaccination exists against it. Smallpox was known for its fatality rate but it has since been eradicated from planet earth due to prompt response by the vaccination (Wang et.al, 2016). Influenza came into existence after humans began domesticating pigs. Because of the nature in which influenza replicates and mutates so readily, it is still a challenge to public health organizers even after developing vaccines against it. In seasonal pandemics, influenza has a high mortality rate. Tuberculosis, just like influenza came as a result of domesticating an animal. Domesticating cattle resulted in tuberculosis .TB is a major concern in the public health sector for two main reasons. Statistics show that one individual out of three carries the TB causing bacterium. The duration of time taken to medicate TB is long hence most strains of TB develop resistance to the drugs. This points out to the need to enhance its vaccines so as to cater to other strains of the disease. Beyond any doubt, as of the year 2010, HIV/AIDS was responsible for an estimated 40million deaths. Whereas HIV/AIDS has no vaccine, the other disease mentioned above have vaccines. Smallpox vaccine has eradicated the disease from the world. A preventive vaccine for TB is readily accessible although it is not useful to all recipients, hence not utilized in some parts of the world due to health policies.

Emerging diseases such as Acquired Immune Deficiency Syndrome and drug-resistant microorganism forces scientists to find new ways of prevention and treatment of the diseases with potential to wipe out the human race (Smith et.al, 2011).. Threats to health in a planet facing harsh climatic change and ecological disturbance pose dangerous consequences for all human beings. With the sloe rates of vaccine development, the world’s needs to put more effort on meeting health needs through efficient vaccines.

The evolution of vaccination is an ever-changing procedure; disease-causing pathogens alter, as the surroundings and hosts (Smith et.al, 2011).. In order to be well equipped to face the problems ahead, it is vital to acquire the understanding of the past experiences and enhance vaccines administration. Although currently there are a lot of new things that need to be learned, many current argument and controversies are as a result of past activities and misconceptions on vaccines.

 In short, Vaccination relies on science and systematic structures put in place to produce a community, statewide and countrywide conditions that promote health, prevention of diseases and promote healthy living styles across the entire world. Good health does not only result from proper health care but also from the constant effort to make vaccines good public policies and programs to safeguard and advance the health of all individuals. Example of public efforts aimed at improving the health of a community include educating  the society on healthier decisions, raising awareness  of the benefits of physical vaccination  and other preventive measures of  disease outbreaks and the spread of common infectious diseases, ensuring availability of safe basic needs.

References

Castle, J. C., Kreiter, S., Diekmann, J., Löwer, M., Van de Roemer, N., de Graaf, J., ... & Koslowski, M. (2012). Exploiting the mutanome for tumor vaccination. Cancer research, 72(5), 1081-1091.

Wang, Z., Bauch, C. T., Bhattacharyya, S., d'Onofrio, A., Manfredi, P., Perc, M., ... & Zhao, D. (2016). Statistical physics of vaccination. Physics Reports, 664, 1-113.

Smith, P. J., Humiston, S. G., Marcuse, E. K., Zhao, Z., Dorell, C. G., Howes, C., & Hibbs, B. (2011). Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public health reports, 126(2_suppl), 135-146.

Turnock, B. (2012). Public health. Jones & Bartlett Publishers.

Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: a randomized trial. Pediatrics, 133(4), e835-e842.

Larson, H. J., Cooper, L. Z., Eskola, J., Katz, S. L., & Ratzan, S. (2011). Addressing the vaccine confidence gap. The Lancet, 378(9790), 526-535.

Relationship between Quality and Cost of Healthcare Services

Abstract

            There are few facts about the relationship between quality and cost of healthcare services. Most theories suggest that quality care is achievable only where there is high cost during care delivery. The results of the research have shown that through collaboration of the health care stakeholders and participating in contribution of funds improves the quality of care. The conclusion is that is not a must to have money in order to get quality care in the health sectors but through efforts of working as a team will enable the achievement of quality care.           

Introduction

            Health care system involves meeting the health needs of a particular target population are an organization of people, given institutions and resources through activities and efforts to improve quality of the health and health determinants. In most cases, quality care is seen where the patient is paying much as compared to cases where the costs are low or free. The quality of care delivery is related to cost depending on the present incidences of occurrence. Quality care is achieved through different significant activities and not necessarily the high costs.

Activities and the Roles Done By Public Agencies in Addressing Cost and Quality Healthcare

            Agency of Healthcare Research and Quality is one of the public agencies that play an important role in addressing the issue of cost and quality health care (National Research Council, 2005). It contributes to the federal funds through multiple agencies in order to solve the issue of cost and quality care faced by the entire health care system of America. This ensures that there is enough funds to enhance quality care delivery under low cost

 Activities and Roles Performed by private Agencies in Addressing Cost and Quality Healthcare

.           The National coalition on health care, a private agency, aims at addressing the challenges of cost reduction and quality improvement in both private and public sectors. Its main role is ensuring effective collaborations and sharing the responsibilities between all the important members of health system (Page, 2015).This will ensure that there are valuable and affordable health care services for the patients, employers, other payers and the tax payers

The Current and Projected Initiatives towards Improvement of Quality Care as Cost Is Being Controlled                

             Participation of federal funds contribution to support overcoming the challenge of cost control and quality healthcare is one of the current steps that have been taken by the agencies (National Research Council, 2005).  The main aim is to ensure availability of sufficient funds to cater for the needs of the patients with the goal of providing quality care. Sharing of responsibilities and active participation by the stakeholders of the health systems is another projected initiative (Page, 2015). It is aimed at achieving valuable and affordable health systems for the sick clients, employers and tax payers.

The Unintended Consequences during Quality Care and Cost Control

            The reimbursement of the policies led to unintentional disadvantages towards safety-net hospitals. They imposed financial burden by threatening the thriving ability of the hospitals and exposing the low-income patients to risk of care (Mattie, 2008). The hospitals have been having decrease access to health care, reduction of per capita income, increased rate of unemployment and increased time wastage while travelling to care facilities to access health care.

Implications of Staff Nurses, Advanced Practice Nurses and Evidence-Based Practice Relative to Cost and Quality

            Measures to elevate the patient’s outcome and quality of care are important in improvement of health care. The agenda of evidence-based practice is the first in the health care system.  It aims at evidence-based practice of care to improve the outcome of the patient and the overall health of the population (LoBiondo-Wood et al, 2018). There is the need for the intra-professional and inter-professional team members to cultivate the evidence-based practice and to be committed towards searching for the literature of the evidence available, developing clinical questions and evaluating tests of change. Meeting this challenge ill help in improving the health of the population, enhance quality care and minimize the health per capita cost. The administrative, education and clinical leaders are therefore urged to lead the organizational and system level change by use of evidence-based practice to improve the quality of cost and improve the health care level

Conclusion

             Quality health care relates to cost which is determined by the present circumstances. There are activities carried out by healthcare agencies with an aim of addressing the cost and quality healthcare. First, there is taking part in contributing in federal funds to ensure that there sufficient funds to cater for the patients and secondly is the engagement of all the healthcare stakeholders to improve quality of care and cost management. Several initiatives to improve cost and quality care have been put in place. However, during the process of quality care and cost control, there has been reduction of per capita income, increased unemployment rates and decreased access to health care. The evidence based practice strategy aims at improving the patient’s outcome and the health of the general population. The educational, clinical and administrative leaders are urged to use the evidenced based practice to the organizational and system levels in order to improve the quality of cost and health care.

Reference

National Research Council (U.S.). (2005). Advancing the nation's health needs. Washington,       D.C: National          Academies Press.

 Page, C. G. (2015). Management in physical therapy practices. Philadelphia: F.A. Davis Company.

Mattie, A. S., & Webster, B. L. (2008). Centers for Medicare and Medicaid Services'" Never        Events": An             Analysis and Recommendations to Hospitals. The health care manager,     27(4), 338-349.

LoBiondo-Wood, G., Haber, J., & Titler, M. G. (2018). Evidence-Based Practice for Nursing      and Healthcare Quality Improvement - E-Book.

Introduction

Ground breaking historical changes are happening in marijuana policy. Over the passing years, marijuana use increased tremendously due to numerous reasons, ranging from medical purposes to leisure use. However, the issue remains contentious especially in America. Under state law, it is categorized as a controlled substance, which makes it prohibited and unlawful under federal laws. In spite of this glaring fact, some states in America legalized marijuana, mainly for health reasons. This essay supports the legalization of recreational marijuana, although it will look at both sides of the argument and explain the underlying reason for its choice.

Background of the Debate

In the year 1996, California electorates officially permitted the compassionate Use Act, which detached criminal punishments that came as a result of having, utilizing, and nurturing medical marijuana (Fisk, Vonasek, & Davis, 2018). This act stated that medical experts have the right to prescribe or recommend medical utilization of marijuana for medical purposes especially among patients with cancer, AIDS, acute pain, and terminal illnesses. On the other hand, the act permitted patients to choose a caregiver who would administer the recreational marijuana. In addition, the Compassionate Use Act gives cultivators and suppliers some form of shield against the long arms of the law by permitting them to purchase marijuana without a fine. Since it is excessively costly ensuring medical marijuana meant for patients, serve only medical purposes, California lawmakers saw it fit to legalize cultivation of marijuana for recreational purposes so that medical marijuana will only serve its intended purposes.

 Since 1996, 20 more states followed suit and enacted laws, which permit the use of medical marijuana. Even though some states only give each caregiver one patient in order to prevent home gardening and diversion to recreational marijuana trades. By assessing before legalization and after legalization data from states, one thing remains clear: it created supply and demand for the herb (Levisnson, 2018). Even though the impact of decriminalizing medicinal marijuana on ingesting is helpful, the impact on price may be negative or positive. According to (), price data gathered from 1990 to 2011, for the sole purpose of monitoring the impact of the legalization on the market, the data revealed that permitting marijuana decreased its quality by 10-26% which in turn affected price. More over the supply increased more than the demand. The author also claimed that medical and recreational prices were at par with each other, indicating that the two markets overlapped, which was not the intention of lawmakers while legalizing marijuana. Keeping the two markets separate would prevent any illegal activities and combination of the herb with other drugs.

The states of Colorado and Washington legalized the cultivation and marketable supply of marijuana for both medicinal and recreational reasons. However, these actions remain illegal under the federal law (Newton, 2013). As a result, bulky cultivation of marijuana with tractors and untrained labor cannot take place any time soon. As an alternative, most production takes place under small scale with the use of negligible amenities. Due to the fact that production of marijuana takes place under small-scale conditions, the production is wide spread across states, which lifted the ban on marijuana. Projections claim that the price may fall further since an individual can grow his or her own marijuana.

 The national survey on health is the best source of information pertaining marijuana utilization among adult within America. With keenly observed trends, legalization of marijuana came increase in personal use and cultivation of marijuana plants, which were once prohibited under the law.

Economic Reasons for Legalizing Marijuana

            One of the main reasons for legalizing marijuana is to create employment and monitor its use among users. For starters, legalization of marijuana generates income for the states and the national government. Marijuana data evaluation unveils that direct authorization of recreational marijuana at the state level led to an estimated $131.8 billion income in terms of tax gathered from states. Frontier data estimated a 15% trade increase in tax sales for the both the state and the national government. It is vital noting that commercial tax tariffs are only 35% hence revealing a potential growth for the marijuana industry.

 Apart from generating income for the states, recreational marijuana would produce jobs for the people supplying and growing the herb. Understandably, even though the economy produces more jobs in other sectors, marijuana would boost opportunities in the job market and ensure stable growth throughout the process (Anderson, & Rees, 2014). Researchers and economic scholars predict a stable growth in the marijuana industry, which in turn would produce an estimated 1.1 million jobs. The jobs emerge from transportation created by demand, cultivation of the herb hence farmer expertise needed, handling the herb after harvesting and retailing of the finished product. All these aspects of the herb present various job opportunities. Therefore, legalization adds to the already existing jobs a considerable amount of jobs. In terms of consulting firms, computer programming that would meet the daily needs of marijuana factories, accounting, and loaning services; constructing companies charged with construction of trade openings and greenhouses. All of the above are job opportunities created by the marijuana industry. The list of job opportunities is endless; nevertheless, the primary point is the jobs are sustainable enough to trigger a change in the economy through both direct and indirect job opportunities.

 The third reason for the legalization of recreational marijuana is investors stand a chance of gaining from the exponential progression of the industry. After creating jobs, investors can actually invest in proper structures that would facilitate the cultivation, production, and commercial distribution of recreational marijuana (Anderson, & Rees, 2014). Moreover, marijuana is not a perfect industry and is likely to face some setbacks, but it is worth investing in it.

The fourth reason for the legalization of recreational marijuana is that it reduces the cost that would go into enacting and enforcing law against the use of marijuana (Anderson, & Rees, 2014). Thus, legalizing marijuana makes the state have it both ways: generating income and at the same time regulating its use through lawful measures rather than prohibiting it completely. Court cases significantly drop which in turn implies fewer imprisonments.

Counter Argument

Opponents of the legalization of marijuana w base their argument on regulation. Legalizing the drug would lead to irresponsible especially among the teen and youths. In addition, they further claim that funds retrieved from legalizing the drug will not overshadow the medical expenses incurred during hospital visits caused by the recreational marijuana (Choo et.al, 2014). Other effects such as addiction and increase in violent crime together with negative effects caused to the surroundings are some of the major concerns to the opponents. One of the most airtight argument by opponents of legalization of marijuana is that even if the use is medical, the effects remain the same and medical reasons do not shield any patient from exposure to short and long term effects of the drug.

Main Argument

 While some people are against the legalization of marijuana, claiming that it is harmful and may have a ripple effect on the larger population, such argument stands on unstable grounds because the government cannot have authority over all things inclusive what aspects that is right or wrong (Choo et.al, 2014). Secondly implementing marijuana laws is not essential and one does not need careful scrutiny to notice mechanism the public use to bypass marijuana laws. The national government makes an estimated 700,000 arrests per year, which is a population of a state, for having marijuana. The arrests disruption the normal flow of peoples’ lives and exerts pressure on prison facilities.

Most people support the legalization of Marijuana due to its usefulness in the medical sector (Choo et.al, 2014). An estimated 84% people claim that the drug has positive medical utilization. Thus, the government should consider legalizing it. To back the claim a medical research proved that smoking pot has medicinal advantages to the smoker.

In short, A part from its medical use, statistics shows more than half a million Americans used the drug in spite of the illegality due to federal laws. As result, legalizing it would add to the government revenue through taxation. Taxation will come with legal jobs and income to the peddlers of the drug. Thus, in the long run, it would boost the macroeconomic of the community. This a win-win situation between the government and the abusers. If alcohol is legal, marijuana too can be made legal.

References

Anderson, D. M., & Rees, D. I. (2014). The legalization of recreational marijuana: how likely is the worst-case scenario. Journal of Policy Analysis and Management, 33(1), 221-232.

Choo, E. K., Benz, M., Zaller, N., Warren, O., Rising, K. L., & McConnell, K. J. (2014). The impact of state medical marijuana legislation on adolescent marijuana use. Journal of Adolescent Health, 55(2), 160-166.

Fisk, J.M., Vonasek, J.A., & Davis, E. (2018).’ Pot’ Reneural Politics; The Budgetary Highs and Lows of Recreational Marijuana Policy Innovation Politics & Policy 46(2), 189-208 doi:10.11 11/polp 12246.

Levisnson,A.H,(2018).Adolsecents Marijuana Use and Perceived Ease of Access Before and After Recreational marijuana Implementationa in Colorado Substance use & Misuse ,53(3),451-456.doi:10.1080/10826084.2017.1334069.

Newton, D. E. (2013). Marijuana: A reference handbook. Santa Barbara, Calif: ABC-CLIO.

 Placenta Encapsulation

 Introduction

Placenta encapsulation is the current and noninvasive way to which a placenta is dried, prepared and put in capsules which are consumed by the mother who gave birth to it (Hayes, 2016). There are two methods in which the placenta can be encapsulated which are the dried merely capsule and the traditional Chinese medicine steamed method.

The traditional Chinese method is the widely used method, and in this, the placenta is considered a sacred and powerful medicine to the woman who gave birth. It is believed in this that a placenta provides energy to the mother. Placenta encapsulation has become popular in recent years in the United States and Canada, and it is now in the United Kingdom and Europe as a service.

Preparation

Most of the women consuming their placenta have either the raw or cooked placenta encapsulated. A large number of them consume it when cooked, and some consume it while raw. The process of encapsulation of the placenta involves cutting the placenta into small strips and dehydrated in an oven and later it is ground into powder and placed in the capsules (Farr et al., 2018). Some of the women who consume it raw, blend the pieces of the organ with fruits.

            During preparation, the placenta is rinsed and rubbed in the amniotic membrane and later steamed from about 15 minutes together with lemon, ginger and even hot pepper. The cooked placenta is then cut into small pieces and dried, and the dried pieces are then ground to form a powder and placed in the capsules. When it is encapsulated raw the placenta I dried without steaming or cooking then crushed and put in the capsules.

The benefits to the women consuming

Mothers who have consumed the placenta have reported having helped them in the reduction of postpartum bleeding. Increased supply of the milk they produce, improve the appearance of their skin, reduced stress and even prevented postpartum depression. They also report improved mood and energy. This is a claim made by the mothers, but there has not been a piece of scientific evidence to support this wholeheartedly. Some of the arguments that have been there are that placenta replenishes the body with nutrients which can include iron, B vitamins, and even hormones that makes the body feel better and reduce fatigue and the depression (Farr et al., 2018). The results from this woman may show that placental consumption can be of great benefit to the woman in the postpartum period

A large number of woman experience postpartum depression after giving birth, and there are activities that occur during the birth process. There will be a drop in the hormone level, there is also blood loss and fatigue. All of this is thought to be the factors that result in the development of post-partum depression. A mother with the condition may present with sadness, weeping, feeling of dependence, might also lack concentration and be anxious. The symptoms might cause a significant impact on the life of the mother and might also find it difficult to take care of the baby.

 Placenta consumption is reported to improve the mood and reduces fatigue in that, the placenta contains iron, and thus its consumption replenishes the body with the iron after birth. In women who do not have anemia, ferritin concentration increases in the placenta, and this occurs in the third-trimester and the amount of iron in this placenta are measurable in both dried and fresh.

Besides, the enhanced mood and reduction of h postpartum depression are also purported to be attributed to the B vitamins which are thiamin, riboflavin, and pyridoxine which are all present in the human placenta. During processing, B vitamins may be destroyed, and thus it may alter the vitamin content after the processing. However, even if the placenta is consumed raw, there is little known if it will reach the required concentration to make it beneficial for postpartum women (Hayes, 2016). Besides, it is also not clear with regards to the function of B vitamins in prevention of postpartum depression.

It has also be claimed that placenta consumption will replenish the body with the pregnancy-related hormones which help in the prevention of the postpartum depression which may result due to a rapid decline of this hormones after birth (Hayes, 2016). Withdrawal from the Estrogen may to some extent lead to postpartum depression, but it is not yet understood clearly as to what role does the change in the hormonal level play.

Studies that had been performed shows that transdermal use of estrogen administration in the management of the postpartum depression. There were also claims that consumption of placenta may also decrease postpartum depression symptoms through beta-endorphins. Estrogen and the beta-endorphins are usually there in human placenta, but it is not yet clear on the concentration of the hormones in the placenta after it has been processed for consumption by the mother.

Reproductive hormones contribute to emotional processing, motivation and even cognition and thus it contributes indirectly to the postpartum depression through the influence of the social and the psychological risk factors for depression. However, they also affect the biological systems which play a significant part in the depression and thus, it has a direct impact on the postpartum depression (Young et al., 2016). Most women who have consumed placenta report that their placenta helped them manage their postpartum depression as compared to the depression they had during their previous pregnancies.

The proponents of the placenta consumptions also assert that it results in improved milk supply that is for women who practice breastfeeding. The self-report from the women indicate there is improved lactation (Young, 2016). Studies that had been done earlier also showed that women who consumed their placenta had increased in the size of the breast and increased in supply of the breast milk, although the study had a number of methodological limitations in which the consumption was done in the first four days following delivery. Which is the period where milk is highly produced in the mammary glands.

Placenta consumption has also been linked with pregnancy-mediated loss of pain sensation which is an opioid-mediated. Consumption of the placenta decreases the pain through facilitating endogenous opioid influence which are generated during the period.

There are lot of benefits that the mothers who consume the placentas claim to get. However, consumption of the placenta also comes with some adverse effects. Some of the reported adverse effects are a headache (Young, 2016). There is no research that has been carried out on the potential harm that may result from placenta consumption, but the theoretical view states that, the risk that may be in place is caused by the transfer of pathogens in the placental tissue into the body, the estrogen activity and the environmental toxins that may be present on the placenta.

It also exposes the mother and those who handle it to disease causing microorganisms that may be in the tissue, for example, organisms such as the hepatitis virus. Furthermore, if the woman is exposed to any intrauterine infection which can occur during the labor or even during birth she might then expose herself to infections that may result after the ingestion of the organ (Buser et al., 2017). This will hinder the healing process and thus have an adverse effect on the overall recovery.

The proponents of the placenta consumption have supported the practiced based on its benefits, although there is substantial evidence to support the reports. Most women reports that they have had less postpartum depression has compared to their past pregnancies; thus without even the extensive research on this. There have been more reports on benefits than complications resulting from this, therefore there are little negatives on consuming your placenta as long as it does not bring harm to the body and it improves the experiences of life. Placenta has plenty of nutrients needed by the body that are lost during the pregnancy and at birth; and thus consumption of placenta to replenish the body give more benefits than harm

Implications

With the rise in the number of women in their postpartum period consuming their placenta, it is necessary for the care providers and the midwives to have knowledge on the practice. They should be mindful of the evidence concerning likelihood of benefits and risk and also how they the placenta is prepared, to give the client the necessary information they might need concerning this. They should even have appropriate knowledge on the policies and regulations which may impact the families who decide on the method.

The midwife also needs to be aware of other benefits including the pain relief, improvement of mood, increase in energy supply and other risk such as the risk for infection and contamination by heavy metals. This will enable the care providers to give the necessary information concerning the placenta consumption for them to make informed decisions.

After provision of the necessary counseling and the client chooses to consume her placenta, advice on the criteria they should consider when preparing the placenta is essential. The placenta preparation should ensure that proper and safe handling is practiced. They are training on handling and disposal of infectious waste to prevent contamination. It is also necessary to teach all the woman who chooses to consume their placenta on how it is prepared whether it will be cooked or taken raw and also show them on the risk that accompany consumption of the raw placenta.

Scientific research is in place for the evidence-based benefits and risks for placental consumption and is in their early phase, and thus there is a need for double-blind trials which will examine the potential risk and benefit of the encapsulated placenta, currently the most commonly used. The priorities being to investigate how the capsules work (mode of action) for the potential risk and benefits that the capsules have. This is done using valid and measures that are reliable and use of the sample size large enough to detect the rare events that may be associated.

References

Buser, G. L., Mató, S., Zhang, A. Y., Metcalf, B. J., Beall, B., & Thomas, A. R. (2017). Notes from the field: late-onset infant group B Streptococcus infection associated with maternal consumption of capsules containing dehydrated placenta—Oregon, 2016. MMWR. Morbidity and mortality weekly report, 66(25), 677.

Farr, A., Chervenak, F. A., McCullough, L. B., Baergen, R. N., & Grünebaum, A. (2018). Human placentophagy: a review. American journal of obstetrics and gynecology, 218(4), 401-e1.

Hayes, E. H. (2016). Consumption of the placenta in the postpartum period. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(1), 78-89.

Young, S. M., Gryder, L. K., Zava, D., Kimball, D. W., & Benyshek, D. C. (2016). Presence and concentration of 17 hormones in human placenta processed for encapsulation and consumption. Placenta, 43, 86-89.

Young, S. M. (2016). Effects of human maternal placentophagy on postpartum maternal affect, health, and recovery.