How to Prevent a Disease

Introduction

Microorganisms, commonly referred to as germs go into the body, reproduce and interfere with regular functioning of the body. Communicable infections are the leading causes for sickness and even death all over the world. Therefore, it is important for individuals to develop healthy habits averting germs and infectious illnesses from distributing. For instance, proper management and preparation of food, washing hands regularly with disinfectants and not sharing personal effects are some habitual ways of preventing infections and spread of diseases. This paper will look into each habit in detail.

Washing hands regularly

 The hands are the most active part of the external body. No human task can take place without the input of hands. Correspondingly, hands collect germs over time and they need washing. One of the most vital well-being habits is regular washing of hands. Humans’ hands transmit microorganisms thus vital to wash them on a regular basis even if they are not dirty.

 Previously, during and after making foodstuff, before partaking food; before and after taking care of a ill patient; before and after tending to a wound; after gusting the muzzle or sneezing, after utilizing a lavatory, after exchanging an infant’s diapers or washing a kid who came out of the toilet; after coming into contact with garbage and finally after petting an animal or animal fecal matter.

 The actual process of washing hands should be effective. First, wet the hands with hygienic water. The water may be lukewarm or cold. Then, close the tap and smear soap detergent on the hands. Secondly, lather the hands by rubbing against each other. Lather the hands on all sides including the backside, palms, fingers, in between the fingers and nails. Thirdly, brush the hands continuously for around one minute. Some people use timers but it is not necessary timing the rubbing. Instead, one can hum a song during the process. Fourthly, rinse the hands under uncontaminated water. Lastly, dry the hands with a dry clean cloth or a drying machine if you have one.

Proper Management and Preparation Of Food Safely

 Germs can infect food. Washing hands, plates, cooking pots, cups, and kitchen surfaces frequently used when making foodstuff is a highly valuable practice. Food storage at the appropriate temperature may inhibit germ infestation. Correct food sanitation means knowing how to avert the distribution of germs while cooking, making and storing food. Uncooked food need proper storage facilities and one needs to handle uncooked foods with proper care to avoid food poisoning and other dangerous issues.

 There are four distinct ways of keeping the food harmless at home. First, ensuring hands, exteriors surrounding and kitchen apparatus are in proper hygiene before, during, and after preparing food. Secondly, while cooking food, one must ensure the food cooks properly through the entire cooking process to eradicate unsafe microorganisms. Thirdly, storing foods under the right temperature slows down the growth of disease causing organisms. Most fridges have temperature-regulating buttons, which helps a user set the right temperature hence one can choose medium temperature or adjust according to longevity. Fourthly, circumventing cross adulteration by preventing the disbursement of disease causing organisms on ready to eat foods staff. Handling food goes hand in hand with cleaning hands and utilization of clean dishcloths as unclean ones may harbor disease-causing microorganisms. Therefore, one should always wash dishcloths and then hang then to dry for the next use.

 In terms of eating and cooking foods, always reheat foods when it goes cold. Destructive bacteria die during cooking and reheating cold food for a certain length of time only ensures the foods remains safe for a longer duration. In addition, some foods contain instructions hence before cooking one needs to read the full manual.

Avoid Sharing Personal Items

 It is difficult sanitizing personal items such as combs, cloths, and toothbrushes in between showers. In fact, sharing personal effect is not wise and some items cannot be recurrently utilized. If you want to avoid a flu or an illness more grave, one can make a point of keeping their personal belongings to themselves and keep away from other people’s personal staff, body fluids such as blood and saliva. For instance, if a person has a flu, covering the mouth with both hands while sneezing or coughing is commendable. However, if one does not wash their hands after the cough and use same hands to scoop lip gloss, the probability of spreading the disease to the owner of the lip gloss is high. Therefore, next time someone uses the lip gloss, he or she will get the flu.

 In summary, to avoid or prevent the spread of diseases one should wash their hands regularly, that is before, during and after taking a meal to avoid transmitting germs into the food they are eating and then ingesting it into their bodies. Secondly, the kitchen surface utensils needs washing regularly before handling food. While cooking one should cook the food thoroughly killing all the germs present.

Health Equity

Infant Mortality  

Human beings have the right to health but in order to ensure that individuals have access to quality health care, the public health workforce should promote health equity and social justice.  In many countries, individuals are suffering from health disparities and lack of equity as a result of poverty, powerlessness, discrimination, race, ethnicity, and sexual identity, among other genetic and biological factors, and social and economic conditions (Braveman, 2014).  Health equity means that all human beings regardless of age, gender or sex should receive equal treatment.  The article by Brown et al, (2017) reports that health equity is a topic of discussion since there is Black-White infant mortality gap in the U.S.   Despite a 13% decrease of infant mortality rate that was noticed in 2000 to 2013, there are racial disparities among African Americans.  The higher rate of infant mortality is as a result of social, economic and structural factors (Brown et al, 2017).  Despite the national effort to eliminate health disparities,   African American continue to suffer from racial disparity.

  The article points out that studies and researches on health disparity have done a significant role in identifying and analyzing the risk factors for health disparities.  However, the studies have not put concern on the need to eliminate disparities.  There are very different patterns of infant mortality in Black and White communities since disparities in the African American community is worsening compared to white communities where individuals are enjoying equity and equality (Brown et al, 2017).  The article used an evidence-based approach to prove the gap that exist between African American and White infant mortality. In conducting the study, cohort files were used to derive data of infant mortality rate in state-level from 1999-2013 (Brown et al, 2017). The purpose of this study was to show an equitable reduction. The results showed a gap between Black and White infant mortality rate especially in States like Arizona and Massachusetts. For example, from 1999 to 2013, 64876 babies died in 35 African American States (Brown et al, 2017).  The major findings from the study were that   States employed strategies to eliminate Black infant mortality but there is no effort to address the issue of Black-White disparities. Even though the State is working hard toward solving the issue of Black infant minority rate, there is variation in progress toward achieving equitable outcomes.  The solution to this problem is addressing the Black-White gap in order to achieve equity and equality in the future.

The article contains actual points that would be better articulated by health equity. First, the article states that the higher rate of Black infant mortality is as a result of pathological causes such as low birth weight, and prematurity (Brown et al, 2017).  Other upstream and downstream factors such as socioeconomic stress, lack of adequate nutrition, exposure to risk factors, and lack of access to quality care, poverty, limited education, and lack social capital contribute to the higher rate of infant mortality rate.  These factors show that health equity is an issue of concern because the health of African Americans is getting worse over time. There is a need for social justice to eliminate the gap between the advantaged and less advantaged groups (Brown et al, 2017). The article clearly shows that the health difference or lack of equality between Black and White communities is linked to economic and social factors such as gender identity, ethnicity, gender, geographical location among other characteristics.  African American pregnant women lack prenatal care, good nutrition, and lack of quality health care due to the highlighted factors.

 The article has shown concern in promoting health equity by stating that there is a need for a multidimensional approach or in other words a multilevel intervention. The article puts emphases that the approach should be directed toward strengthening the Black communities to promote equitable outcome and eliminate social and economic inequalities (Brown et al, 2017).  In addition, there is a need for effective partnerships and multi-sector collaboration in addressing the issue of infant mortality rate.  Different stakeholders such as the health care organizations, community-based organizations, justice agencies, education sector, and public health agencies among other agencies should combine skills and provide resources to promote health equity.

 References

Braveman, P. (2014). What are health disparities and health equity? We need to be clear. Public

health reports, 129(1_suppl2), 5-8.

Brown Speights, J. S., Goldfarb, S. S., Wells, B. A., Beitsch, L., Levine, R. S., & Rust, G.

(2017). State-level progress in reducing the Black–White infant mortality gap, United

States, 1999–2013. American journal of public health, 107(5), 775-782.

                                                             Introduction

            Dyspnea is one of the common universal symptoms for the majority of patients who are at the last stage of the pulmonary disease. At least half of the patients suffering from other life-limiting disorders, for instance, neuromuscular disorders and heart failure end up experiencing episodes of breathlessness, regardless of the therapeutic intervention given to control the disease process (Beth, 2015).

1. a) What evidenced-based nursing intervention(s) is (are) important per the article?

In most cases, physicians always encounter several patients troubled with the same symptoms. One of the means of responding quickly to them entails reacting quickly although the available interventions are the ones which have been proven to have the ability of supporting respiration in the ABCs of emergency responses.

                        Conversely, in the process of caring for a dying, in which comfort and not rescue is the ultimate objective, at times it becomes impossible for nurses to intervene. This together with other barriers restricting quick relief of distress has been recognized to have serious consequences for the surviving families and close cycle of friends. Taking into account the current methodical reviews of the main priorities of the end-of-life care, the truth is that patient rated symptom relief is one of the top ranked elements of medical care.

                        The above integrative assessment is the one that aid in confirming these results, hence highlighting the general significance of effective and rapid symptom relief as being ultimately important to patients and their families. Despite that, it should be understood that families and patients might be dissatisfied with the kind of medical attention given to them. The reason for that is because it has been recognized that physicians at times end up being frustrated by some of the institutional barriers in the process of trying to offer quick symptoms relief for some of the dying patients. As result of that, Code Comfort has been perceived as being one of the main approaches that have the ability of overcoming these barriers (Beth, 2015). Ideally, such a strategy has been designed for patients who desire not to resuscitate their status, the policies of the Code Comfort including procedures for managing acute signs and symptoms, for example, dyspnea, agitation, anxiety, and pain.

1. How will you incorporate these interventions into your nursing practice?

            Taking into account the some of the current standing orders, it implies that patients’ physicians are mandated to be able to implement various interventions aimed at moderating symptoms immediately. As a result of that, for some of the severe symptoms or moderate symptoms, as a nurse, it is important to activate the Code Comfort team. The reason for that is because it the one that can aid in fostering quick responses for an emergency condition.

            On the other hand, in the process of including these interventions to my nursing practices, it is vital to understand that individual responses to the Code Comfort will have to take into account chaplains, RTs, nurses, as well as prepared palliative care individuals.  Guided by evaluations and other intervention algorithms, it is important, as a responder, to ensure that I have worked swiftly in providing quick symptom relief. Ideally, the reason for that is because it has the ability of supporting the patient’s nurses, and family from the various distresses that they might be experiencing by that time (Beth, 2015).

            Regardless of that fact that a person can be in a clinical institution that lacks the same protocols, there are various strategies that ought to be implemented as a physician. The reason for recommending these strategies is because they have the ability of preventing as well as relieving the suffering of breathlessness of the dying patients as well as supporting their loved ones. As a result of that, it implies that another possible means of incorporating these interventions to my nursing practice entails enlisting the assistance of the patients as well as their families to aid in assessing and identifying therapeutic approaches. Such an assessment should also take into account evaluating the symptoms that the patient might have encountered earlier and what they mainly use to relief their pain.

1. How will you evaluate the outcomes of your intervention(s)?

            In order to act rapidly, it is vital to ensure that I have the ability of streamlining the clinical systems so as to be in the position of obtaining appropriate medications to all the patients who might be experiencing symptom pains. According to the modern research, it has been recognized that some of the therapeutic policies which has the ability of impeding rapid medical care, for instance, those forcing nurses to document RT, has the potential of harming patients as well as their loved families. As a result of that, it is important as a nurse to ensure that I have audited by unit on a timely basis to some of the therapeutic distressing symptoms. In this case, it is vital to take into account the time that elapses when a patient demands nebulizer, antiemetic, or analgesic, as well as when it was given.

            To streamline these interventions, it is important to ensure that the same therapeutic processes have been streamlined and the available barriers dealt with. The reason for ensuring that there is consistent medical care in the room is because abandonment of patients during distress is one of the helpless horrible feelings. Emotional support, and presence, ongoing monitoring, non-pharmacologic treatment, for example, fan use, distraction, and repositioning ought to be implemented (Beth, 2015). The reason for that is because it is these activities that give time for clinical treatments to be prepared as new orders are being requested for.

            Another means of evaluating the outcome of the intervention entails assessing the impacts of the relationship developed with the patient and the nurse. Ideally, it is important for medical parishioners to ensure that they have dedicated enough time in establishing a solid relationship with patients. The reason for that is because symptom distress has been clinically perceived as being one of the emergency situations for dying patients

                                                            Conclusion

            As a medical practitioner, it is important to give patients and their respective families enough time to take action in the process of addressing such distressing symptoms. The reason for that is because breathlessness is one of the factors that have been perceived to be worsening with anxiety, which is ultimately worsened as a result of the lack of control or continued hospitalization. Such a scenario will have to take into account some of the actions that they come up with in the process of handing those symptoms at home. Since quick treatment is the main goal, evaluating its effectiveness will also take into account the manner in which it could have promoted patients’ comfort as well as the healing of their family members who could have been troubled with those final hours.

                                                            Reference

Beth F. (2015). Code Comfort: Prompt symptom relief in end-of-life care. Wolters Kluwer Health, Inc.

                                                                        Introduction

            As far as this ailment is concerned, inflammatory bowel disease (IBD) is some of the commonly known systemic inflammatory ailment in patients.  Clinical research suggests that IBD is basically the collection of Crohn’s disease and ulcerative colitis that develops as a result of the various factors, particularly genetic and environmental ones. From that perspective, Crohn’s disease is also known to be associated with persistent intestinal inflammations with other gastrointestinal signs such as pus and bloody stool, weight loss, fever, abdominal pain, and diarrhea. From the earlier assessments that have been conducted on patients suffering from Crohn’s disease, the disease have been found to show some characteristics of fibrosis, transmural inflammations and mainly exists as patchy cuts or wounds all over the human gastrointestinal tract.

            On the other hand, due to the fact that inflammatory bowel disease (IBD) is linked with various venous vascular problems, for instance, intense venous thrombosis, the level of risks they pose, especially coronary artery disease, to patients is not yet accounted for. Although such patients have a high risk of developing venous thromnoembolism as compared to the general population, such risks are always higher during the severe disease flares. The reason for that is because of the tilting of the active inflammations between the balance that occurs between anticoagulants and pro-coagulants hence resulting to characteristic hypofibrinolysis observed in IBD.

            As stated above, to date physicians have to yet found the main cause of Crohn’s disease. Despite that, the only thing they have proved from their researches is that the long-term inflammations that induce Crohn’s disease have the potential of making a person to have clogged blood vessels, especially arteries. It is this clots that have the ability of filling the inner walls of the arteries with small deposits of fats termed as plague. In case one piece grows bigger to block the normal flow of blood, or loosens and breaks off, a person will have high chances of having a heart attack or stroke. This is a condition termed as atherosclerosis. The manner in which this ailment increases the chances of a person developing such a condition is mainly based on his or her autoimmune conditions, for instance, rheumatoid and lupus arthritis. This implies that they all depend on what an individual’s body generates during long-term inflammation.                   

                                                            Literature review     

            According to the current medical research, cardiovascular disease (CVD) has the potential of emanating from inflammatory bowel disease (IBD) and chronic inflammation as one of the ailments that end up increasing heart failure considerably. Basically, the common incident of inflammatory bowel disease, that refers to either Crohn’s disease or ulcerative colitis, have increased extensively in various nations hence considered to be one of the main factors for CVD (Hankey & Eikelboom, 1999). Due to the fact that inflammatory bowel disease (IBD) has the ability of promoting the development of venous thromboembolism, the truth is that the influence it has in arterial hardening, ischemic heart disease, atherosclerosis, and myocardial infarctions are some of the factors that are under debate. Regardless of that, these kinds of research indicate that the assessments that were initially done on patients have revealed the connection of inflammatory bowel disease (IBD) with increasing heart failure or syndrome (Oussalah et al., 2011).

.           Despite that, it has been demonstrated that IBD has a wider association with heart disease. The reason for that is because the systemic inflammation that has been observed in patients suffering from IBD is the one that results into oxidative stress as well as high levels of inflammatory cytokines. Taking into account the negative impacts of these factors, clinical research suggests that because of the compromised lipopolysaccharides, endotoxins, and intestinal mucosal barrier that are generated by intestinal microflora, the products generated later on have the ability of entering blood circulation. In so doing they activate or stimulates inflammatory responses in the body. It is these responses that later results into the development of atherosclerosis in a person (Wu et al., 2016).

            Besides that, it has been suggested that heart failure and other associated diseases are the main cause of morbidity and mortality globally, despite the outstanding medical advancements in both the evaluation as well as the management of the ailment. Conversely, cardiovascular disease (CVD) has been proven to have the potential of arising from genetic, dietary, environmental, and other lifestyle factors. Furthermore, the available evidence indicates that inflammation is a significant player or factor in atherosclerosis, atherogenesis, and the pathogenesis of heart ailment. Medically, it has been proved that a large percentage of patients suffering from rheumatologic ailments could have the likelihood of suffering from coronary heart diseases (Wu et al., 2016). Therefore, it is important for them to seek medical attention, particularly the monitoring of CVD as one of the regular evaluation of the progress of their condition.

                                                            Meta-analysis

A graph of Weighted mean difference (WMD) against the number of patients with hyperhomocysteinemia in IBD (inflammatory bowel disease)

                        100

                        90

Number   of   80

Patients   in    70

            %        60

                        50

                        40

                        30

                        20

                         10             Weighted mean difference (WMD)

-3         -2         -1         0          1          2          3          4          5          6          7          8          9

            According to the meta-analysis conducted, it was discovered that there exist an elevated risk of ischemic vascular ailment in several patients suffering from IBD and not the events they experience as a result of minor arterial thromboembolic. It was also recognized that although patients analyzed did not show signs of elevated incidences of developing obesity, experiencing hypertension, or dyslipidemia, they still show a higher risk of developing coronary artery disease (Oussalah et al., 2011). Despite the fact that for a prolonged period of time systemic inflammations has the potential of causing platelet aggregation as well as endothelial dysfunction, the truth is that there is an outstanding probability that is these events that have the ability of increasing the development of CVD and atherosclerosis. With hyperhomocysteinemia in IBD (inflammatory bowel disease), it was noted that the increase in C-reactive protein and inflammatory cytokines are some of the factors are the main mediators of eventual atherosclerosis and endothelial dysfunction in the patients under assessment (Singh et al., 2014).

            On the other hand, it was noted that arterial hardening or stiffness was found to be associated with the circulatory levels of the inflammation generators in healthy individuals, and hypertensive subjects. During the analysis, it proven that for a prolonged period, the occurrence of arterial stiffening in patients with IBD was fundamentally associated with endothelial dysfunction and the duration of the disease and not to do with atherosclerosis itself. As a result of that, it was clear that the principal mechanism for systemic inflammations in inflammatory bowel disease (IBD) was essentially based on the dysfunction of an individual’s intestinal immune system as well as their normal cross-reactivity against the host epithelial tissues (Kristensen et al., 2013). Likewise, during the meta-analysis, the majority of the subjects under study were found to have spoiled intestinal mucosal layers. What was speculated to be the main cause is the mixing of the blood with some products that gets secreted by intestinal microflora.

                                                            Discussion

            Although the exact causes of this ailment is not yet known, in genetically vulnerable people, it is assumed that it is caused by the combinations of immune, environment, as well as bacterial factors.  Basically, the meta-analysis conducted proves that the disease also causes persistent inflammatory disorder, in which an individual’s immune system ends up attacking gastrointestinal tract, most likely aiming the microbial antigens (Kristensen et al., 2013). Despite that, it should be understood that although Crohn’s is ultimately an immune-related ailment, it is not perceived to be an autoimmune ailment. This is to imply that an individual’s immune system is not always prompted by the body itself (Wu et al., 2016). Nonetheless, since this is an immunodeficiency state, about 50 percent of the entire risks are associated with genetics with at least 70 percent having been proven to be involved.

            Individuals, particularly tobacco smokers have been proven to have a high chance of developing this disease as compared to nonsmokers. At times, medical research suggests that this condition often starts after gastroenteritis. Some of the diagnoses are relied on a number of available evidences, including medical imaging, bowel wall appearance, biopsy, and the description of the ailment. Other similar conditions that are used for the purpose of diagnosing this ailment are based on include things like Behcet’s disease and irritable bowel disorder. This is to imply that since this is one of the autoimmune ailments, an individual’s immune system has the tendency of mistaking tissues for threats and hits (Drzewoski et al., 2006). In return this causes inflammations. The only things that is clear from this research is that the inflammation that is caused by Crohn’s disease is what mainly end up damaging the lining of an individual’s blood vessels hence inducing heart disease.

            From the research conducted, it was a clear indication that chronic inflammations resulting from Crohn’s disease are mainly associated with increased risks for heart attack. Regardless of that, it was proven that the majority of these associations might be due to the fact that a large percentage of younger patients have the tendency of having more aggressive ailment with recurrent flares. On the other hand, more severe symptoms are a clear indication of the increased level hyperhomocysteinemia in IBD (inflammatory bowel disease) of which would greatly result into increasing risks of a person having a heart attack (Oussalah et al., 2011).

            Conversely, from such an evaluation, it is clear that individuals with Crohn’s disease have a high chance of developing hardened arteries at a younger age as compared to those who are not suffering from such a condition. However, they appear to be having low rates of diabetes, obesity, as well as other conditions that increases the chances of developing heart disease. The same risks are relatively higher in young adult females, particularly during flares when the ailment is more active and when the symptoms are extremely bothering them (Targan et al., 2010). As a result of that, medical research indicates that individuals with Crohn’s ailment have homocysteine, high sensitivity C-reactive protein (CRP) levels, and erythrocyte sedimentation rates.

                                                Current and future treatments

            Although it is not an uncommon scenario to treat this disease, it should be noted that patients who end up taking high doses of corticosteroids for a long period of time have a high risk of not managing this disease. The reason for that is because such drugs have the potential of accelerating the stiffening of the arteries, which can result into heart failure or heart disease (Targan et al., 2010). Moreover, since such medicines have the likelihood of causing fluid retention, and increasing an individual’s blood pressure, they will in return increase the chances of impairing the normal functioning of the heart (Wu et al., 2016).

            From the clinical perspective, when such medicines are taken excessively, they have been known to have the potential of increasing cardiovascular events. In some groups, the general use of platelet activation inhibitors have been found to be linked with decreased cardiovascular and reduced inflammation events. Even though some of the epidemiological researches have not yet shown any promising improvement in cardiovascular disease (CVD) outcomes, the use of drugs such as anti-TNF meds have been suggested to have the ability of decreasing it in individuals suffering from rheumatoid arthritis (Q, A. A. P. D, 2012).  Conversely, the intake of other initially accepted drugs such as anti-platelet activation agents clopidogrel, aspirin, and statins have been proven to be able to reduce the risks of CVD in individuals suffering from inflammatory bowel disease (IBD).

            In case the disease makes a person to keep on going for long calls or short calls during bedtime, it means that the ailment is depriving him or her quality sleep. The reason for that is because medical research has proven that poor sleep is also one of the main factors that accelerate the development of heart disease. As a result of that, it is recommended for a person to seek consultations with his or her doctor so that he or she can receive proper medical attention. Some of the blood tests that can be done on a patient will ultimately assist in assessing whether he or she has clogged arteries (Drzewoski et al., 2006). Other imaging tests are also vital in checking inflammations in blood vessels and heart disease in such patients.

            Likewise, in order to be in the position of lowering the chances of heart failure or heart disease, it is important for patients to keep their disease under control as well as prevent flare-ups. This is what can boost the heart to recover from such a disease in the process of taking some of the heart disease medicines prescribed by the doctor. In the near future, significant advancement in curative modalities in treating cardiovascular disease is the one which have also been noted to have the potential of reducing CVD-related deaths (Descovich, 1990). To better understand the effects of this disease, it is important embark on investigating the connections that exist between the disease and the blood clots in human veins.

                                                            Conclusion

            Inflammatory bowel disease (IBD) has been noted to pose a high risk for the development of cardiovascular disease and heart failure. The incidences of this disease in conjunction with Crohn’s ailment have greatly increased globally to the extent of posing imminent risk factors for the development of CVD. Thus, the general implication of IBD in causing various diseases, especially atherosclerosis, ischemic heart disease, and arterial hardening or stiffening, is nowadays under investigation. Nevertheless, systemic inflammations in individuals suffering from this disease are what have been recognized to have the potential of increasing oxidative stress as well as elevating the levels of cytokines in a person. In the process of enhancing phenotypic changes, it ends up culminating the negative impacts of CVD and atherosclerosis in a person.

            Additionally, such a condition proves that patients suffering from inflammatory bowel disease (IBD) end up having deregulated or uncontrolled coagulation system and in case the atherosclerosis plaque breaks off, there is the exposure of thrombogenic core in the bloodstream. This scenario in return leads to the formation of thrombus which results into the development of acute coronary disorder.  The only thing they have proved from their researches is that the long-term inflammations that induce Crohn’s disease have the potential of making a person to have clogged blood vessels, especially in the arteries. Therefore, the general advancements in medical treatment have been recognized as being the ultimate means of diagnosing and treating this disease.

                                                            References

1. Descovich, G. C. (1990). Atherosclerosis and cardiovascular disease. Kluwer Press
2. Drzewoski J, Gasiorowska A, Małecka-Panas E, Bald E, Czupryniak L. (2006). Plasma total homocysteine in the active stage of ulcerative colitis. J Gastroenterol Hepatol. 2006;21:739–743. doi: 10.1111/j.1440-1746.2006.04255.x.
3. Hankey, G. J., & Eikelboom, J. W. (1999). Homocysteine and vascular disease. Lancet, 354(9176), 407–413. https://doi.org/10.1016/S0140-6736(98)11058-9
4. In Ananthakrishnan, A. N. (2016). Nutritional management of inflammatory bowel diseases: A comprehensive guide. Springer Press
5. Kristensen SL, Ahlehoff O, Lindhardsen J, Erichsen R, Jensen GV, Torp-Pedersen C, Nielsen OH, Gislason GH, Hansen PR. (2013). Disease activity in inflammatory bowel disease is associated with increased risk of myocardial infarction, stroke and cardiovascular death - a Danish nationwide cohort study. PLoS One. 2013;8:e56944. doi: 10.1371/journal.pone.0056944.
6. Oussalah, A., Guéant, J.-L., & Peyrin-Biroulet, L. (2011). Meta-analysis: hyperhomocysteinaemia in inflammatory bowel diseases. Alimentary Pharmacology & Therapeutics, 34(10), 1173–1184. https://doi.org/10.1111/j.1365-2036.2011.04864.x
7. Q, A. A. P. D. (2012). Bowel Diseases: ScholarlyBrief. Atlanta: ScholarlyMedia LLC.
8. Singh S, Singh H, Loftus EV, Jr, Pardi DS. (2014). Risk of cerebrovascular accidents and ischemic heart disease in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12:382–393. doi: 10.1016/j.cgh.2013.08.023.
9. Targan, S. R., Shanahan, F., & Karp, L. C. (2010). Inflammatory bowel disease: Translating basic science into clinical practice. Chichester, West Sussex, UK ; Hoboken, NJ : Wiley-Blackwell
10. Wu, P., Jia, F., Zhang, B., & Zhang, P. (2016). Risk of cardiovascular disease in inflammatory bowel disease. Experimental and therapeutic medicine, 13(2), 395-400. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348671/

Holistic healing

Part one

         Recognizing other states of awareness has a lot of benefits especially when it comes to healing someone holistically as it helps to develop understanding of how two or more things can work together to achieve the same goal.  Different states of awareness function on their own without borrowing from each other and may even conflict on one another regarding specific topics (Marquis, 2007).  However, despite their differences, they serve a similar purpose and that is raising their followers' state of awareness regarding their purpose and the world that we live in among other factors. Similar to different states of awareness, holistic healing requires healing the body, mind and spirit as well as acknowledging the fact that different parts of the body may be treated or function differently but all serve the same purpose. Although the states of awareness may function independently, the human systems work together and one must therefore find a balance. 

             The approach is similar to the Christian world view in that it follows the teachings of the bible in relation to the mind, body and spirit.  As Christians, the bible teaches on the importance of purifying the mind body and spirit same as the approach taken in healing someone holistically. As Christians, the bible teaches that the only way to be a true Christian is if the body, mind and spirit are dedicated to following the word of God.  One cannot be fully a Christian if the either the mind or body or the spirit goes against the word of God (Hunt, 2010).  Similarly, holistic healing requires healing of the body, mind and the spirit and the only time one can be whole is if all three are in line.  By learning the different states of awareness, one also learns how to go about healing the boy, the mind and the spirit.  Since the three work together, one is able to find a balance and this is what makes them whole.

Part Two

             Transpersonal psychology has gained a lot of attention over the years mainly because it seeks to explain or clear the discrepancies left by the three movements in psychology.  This is especially because it utilizes other forms of non-ordinary states of consciousness to complete the spectrum of human experiences and is therefore not limited to biological or physical entities but also includes the spiritual element in the human psyche, an inclusion that allows transpersonal psychology to explain how people act in response to their beliefs and state of awareness created as a result of their religious beliefs (Ferrer, 2014). It should therefore be its own movement as it explains the spiritual element in humans, something that the three other movements fail to address and therefore making it the only movement addressing this element of the human psychology.

           The notion of transpersonal psychology is in line with my personal world view in that it requires one to consider things that are unseen or not experienced and pushes one to act on faith.  The spiritual element in humans require them to factor things like religious belief and teachings in understanding concepts that are yet to be explained by other forms of psychology (Ferrer, 2014).  As part of my world view, my understanding of the world and life is a combination of experiences, observations as well as notions based on faith and religious teachings.  Since the transpersonal psychology factors in spirituality, it can help me to make my dissertation better as my understanding will not only be physical or experiences but also spiritual.

References

Ferrer N, (2014) “Transpersonal psychology, science, and the supernatural” The Journal of             Transpersonal Psychology,

Hunt T, (2010) “Consiousness and society: societal aspects and implications of transpersonal       psychology” International Journal of Transpersonal Studies

Marquis A, (2007) “What is integral theory?” American Counseling Association

Blood Donation

Introduction

Blood donation is that process where an individual of appropriate legal age for donation has blood drawn from them, which are then used later to transfuse other individuals who need it or can be processed into biopharmaceuticals. Most of this is either donation of whole blood or specific blood components. The collection process is done in the blood banks, and currently, the contributions are mostly from unpaid volunteers who do that for a community supply.

History of blood donation

The history of blood donation began centuries ago when bloodletting was practiced in Egypt. This was later faced out since it was not effective. It was until 1616 when Dr. William Harvey discovered the human circulatory system that made a huge step. Later in 1665 Dr. Richard Lower made and recorded transfusions from dog to dog which were successful, and it was then followed by transfusion of animal blood to human beings which resulted in a loss of life

 In the year 1818, there was a successful transfusion of blood to a mother who got post-partum hemorrhage after delivery (Charbonneau & Smith, 2015). Later in 1901, the blood groups A, B, and O where discovered, this leads to an understanding of the importance of matching blood groups and the rejection of blood by the immune response. In 1914, Dr. Hustin found a way of preventing blood coagulation through the mixing of blood with sodium citrate and storage by refrigeration.

 The plastic backs for storing blood were invented in 1948; this made improvements on blood banking which used vacuum bottles (Charbonneau & Smith, 2015). Blood donation has significantly improved since then with a various test being taken before and after the donations to screen for potential abnormalities. Following the discovery of HIV/AIDS, it was then essential to test for the virus in every blood donation. Currently, there is the existence of community blood donation centers and other blood bank centers where individuals can visit and donate blood.

Benefits of blood donation to the society

 Blood donation saves lives of individuals who are at higher risk of dying if in case they are not transfused, for examples those people with sickle cell disease and burns (Marrow et al., 2015). With the donation from people, there will be blood available for them, and this will bring joy to them and their families. It also improves the flow of blood since it reduces the viscosity of blood which might have resulted in damage of the blood vessels or causing arterial blockage.

People who donate blood also enjoys the benefits of free health checkups, and this is because a person has to undergo a physical exam and to weigh before donating and after that, there are series of test which is conducted in the laboratory before the blood is transfused to clients who need them. In case of any abnormality then the person is notified and informed, which then follows proper management.

It helps in the regulation of iron in the body. Iron in the human body have usage limits, and thus the excess iron is stored especially in the liver and other body parts, excess iron might cause damage in the blood vessels(Marrow et al., 2015). For those who donate blood, some portion of the iron will be in the donated blood which will then reduce excess iron in the body.

Products manufactured from blood and how patients use them

There are different products manufactured from the blood. Red cells are used to restore patient carrying capacity of oxygen in those with anemia and significant blood loss where other alternatives have not been effective (Koljonen et al., 2016). Another product is platelets which are used in patients with low platelet count and those with platelet dysfunction. Plasma is transfused to patients with deficiencies in clotting factors and who are in active bleeding.

Cryoprecipitate which is made from thawing fresh frozen plasma at four degrees is used as a source of fibrinogen. Granulocytes are indicated for clients with severe soft tissue infections. Crystalloid solutions are used as plasma expanders in patients with acute blood or plasma loss.

Sickle cell disease

This condition is usually present at birth, and it results from an abnormality in the hemoglobin which causes the red blood cells to be rigid with sickle-shaped, this obstructs blood flow and leading to pain and other complications such as stroke (Ware et al., 2017). The condition is usually diagnosed through a blood test which can be done in newborns or adults. The blood sample is tested for hemoglobin S, where if it tests positive then the person has the disease.

The process of blood donation

I was first registered and my body weight, and then I was asked to show my ID. I was given a card which contained all the information about blood donation. I gave out my address including my email. I was asked about my health information, and my vital signs were taken including hemoglobin level. Unfortunately, I was unable to deliver because my hemoglobin levels were 11.8g/dl which was below the requirement. Blood donation is good as it has numerous health benefits, I wish I could donate.

Conclusion

Blood donation began a long time ago, and it has since then developed with numerous discoveries and invention. It has a lot of benefits both to the donor, recipient and the society in general. There are also different products of blood given to patients depending on their need and their condition which can be for example blood disorders or even blood cancers which then require donations. Let’s donate if we can.

References

Charbonneau, J., & Smith, A. (Eds.). (2015). Giving blood: the institutional making of altruism. Routledge.

Koljonen, V., Tuimala, J., Haglund, C., Tukiainen, E., Vuola, J., Juvonen, E., ... & Krusius, T. (2016). The use of blood products in adult patients with burns. Scandinavian Journal of Surgery, 105(3), 178-185.

Marrow, B., Clarkson, J., Chapman, C. E., & Masson, S. (2015). Facilitation of blood donation amongst haemochromatosis patients. Transfusion Medicine, 25(4), 239-242.

Vassallo, R., Goldman, M., Germain, M., & Lozano, M. (2015). Preoperative autologous blood donation: waning indications in an era of improved blood safety. Transfusion medicine reviews, 29(4), 268-275.

Ware, R. E., de Montalembert, M., Tshilolo, L., & Abboud, M. R. (2017). Sickle cell disease. The Lancet, 390(10091), 311-323.

Introduction

 Numerous research concludes that there is a relation between personality and criminal activity. Most of the teenagers take part in some sort of delinquency. For instance, the national youth survey unveiled that at the ripe age of 17 an estimated 65% of all the youths directly or indirectly participate in some form of criminal activity. These delinquent acts differ in terms of occurrence and severity that is, from simple pranks to rape or battering. Psychologists and criminologists for a long time found the correlation between personality and crime intriguing. However, in their quest for answers, members of the two professional fields rarely draw facts from their respective disciplines. Personality psychologists forwarded various well explained theories associating personality to crimes and other rebellious results. In this personal narrative research paper, I discuss the persistence of human personality characteristics and criminal behavior using social learning theories and mental disorder analysis.

Human personality

 I would say that criminological hypothesizing has some loopholes for its selective focus on male personality traits. Given that most of criminal perpetrators are male, it goes without saying that researchers are most likely to evaluate personality traits among men perpetrators instead of taking a general examination among both men and women. For example, in intimate partner homicides, some theories will focus on male personality traits and leave out personalities of their female counterparts (Krueger et.al, 1994). Therefore, gender specific concepts miss the mark during human personality characteristics development; even though the theories may offer satisfactory explanations, they fail to shed light on common variances during crime perpetration.

An author who took a more general view on human personality characteristics was Edward et.al, (2017). Through an empirical study, whose aim was indicating signals reflected in criminal traits, among adult criminals, the author revealed borderline personality, susceptible self-love and psychopathic lifestyle behavior as some of the elements contributing to criminal traits. Whereas dark personality qualities inclines or pushes a person into psychopathic behavior. I totally concur with Edward’s research that due to the rising crime, empirical methodologies function effectively in defining traits or all-encompassing elements of character pathologies that may leave some people vulnerable and more likely to engage in crime. I found outcomes from Edward et.al (2017) research interesting and fascinating at the same time. For example, dark personality traits such as callousness may push people into a life of crime against other individuals whereas impulsive characteristics pushed some people toward property crimes and drug related crimes.

Present-day theories theorize that various aspects lead to development of crime. These theories insist that hostile family surroundings provide conducive platform for the development of criminal characteristics. For instance, luck of proper guidance and absentee parents have the potential to trigger criminal characters in young people as a response mechanism against a broken home (Edward et.al, 2017). More over a broken home leads to social dysfunction such as mistrust and insecurity among the children. A part from social deviancy and lifestyle insecurity, broken homes hinder proper formation of bonds consequently changing attitudes gravitating a child toward criminal activities. I concur that upbringing may facilitate development of criminal traits but even from a functional home, a teenager may become delinquent and perpetrate crime without the knowledge of parents, for example bullying other children.

 I agree with the scholars who suggest that there are certain noticeable personal variances in the steadiness of antisocial traits. Most individuals in the society behave in an antisocial manner but most of the times; their actions may be situational or temporal. On the other hand, antisocial traits of other individuals might be steady and continuously present (Schuessler, & Cressey, 1950). Temporal or situational antisocial traits are very well known in various populations around the world particularly among teenagers. Tenacious, steady antisocial traits exist among a small number of men who possess extreme behavioral challenges and may deteriorate into characters that cause criminal activities.

Initially, antisocial categorization concepts were futile in capturing the thoughts of social scientists even though they articulately gave out more information on personality and crime relationship. Classification concepts normally deviate from well known facts about derivation and results by creating groups disconnected from actual facts. Hence, theories centering on antisocial behavior rely on age specific arrests. When scholars plot amount of misconduct against age, the rates for occurrence and frequency of crimes appear common among teenagers with anti-social personality traits (Sudhinta, 2016). A teenager in his or her early twenties is more likely to engage in crime and the rate reduces gradually as they get older and from new habits and routines hence out growing antisocial characters. Simply put, I agree that antisocial traits contribute to crime among teenagers and as they grow older, the characters subside giving way to a positive outlook.

Mental Disorders and Crime

Five epidemiological inquiries of post-World War II birth peers assessed the connection between crucial mental disorders and criminal activities. These researches took place in the middle of a growing argument on whether or not people with mental disorders were more likely to commit crimes than people with a normal functioning brain. This argument began in the 1960s at a time when in most western industrialized nations, huge psychiatric medical institutions were shutting down and distributing their services to clinic or smaller medical facilities that would not meet patients medical needs satisfactorily. In addition, the argument dispensed from information of penitentiary and prison employees unveiled that progressively, newly admitted prisoners suffered from common mental disorders. In other words, individuals with mental disorders are more likely to end up in confinement due to involvement in criminal activities. Furthermore, compared to people with no mental disorder, statistics show an upsurge in criminal imprisonment among individuals suffering from mental illness after civic upkeep and institutional care programs (Polaschek, 2014). Even more pressing and concerning is the fact that out of a group of five patients admitted in a psychiatric ward, three have a criminal record. Presently, vast psychiatry literature in both North and Europe emphasize that there is no established connection between crime and mental disorder. However, with carefully scrutiny coupled with observations dating back to the beginning of the 20^th century, there is enough proof indicating relation between medical disorder and crime rates. For example, people with schizophrenia and their relatives have a higher potential of engaging in criminal behavior.

 The aim of any epidemiological assessment is evaluation of common mental illness with criminal traits. The studies takes time and conduct a research on criminal behavior among people with mental illness and those with no mental illness or suffer from other types of mental illnesses (Smith et.al, 2014). The assessments had took place in order to meet or fulfill certain practical and scientific needs. The outcomes from study, just like findings from similar studies carried out in previous researches via various methods concluded that there is a connection between mental disorder and criminal behavior, which occurs among birth cohorts. After the confirmation of the association between mental illness and criminal activity, I think it is time for conducting researches with the intention of understanding the relationship between the two aspects.

Personality Traits of Criminals

In my perspective, in order to understand underlying reasons behind a perpetrator’s actions, one must develop an appreciation for multifaceted human behavior. A single aspect cannot define behavior but by identifying various elements, the manner in which those factors interact together, psychologists can formulate patterns and predict behavior and reactions to different things. One obvious oversight made by criminology in terms of criminal personality traits is the exclusion of personality traits concepts from social learning institutions and other types of life programs (Moffitt, 2017). The aim of life programs is raising awareness on identification of criminal behavior and behavioral management hence lack of criminology input delays relevant interventions. To emphasize my views further, inclusion of subjects matter pertaining personality behavior in social institutions and other learning places generates interest and horns the monitoring skills of community members.

Based on the facts revealed by Muncie, (2014), in order to gain insight on the entire criminal personality traits, one must consider emotional, motive and other minor characteristics making a single individual behavior. Simply put, personality is a collection of various characters. In addition, research on personality centers on persistent and durable traits in a person that might point into an entire personality. After defining a personality, patterns become predictable. It is common knowledge that external factors can influence overall human behavior and that is the reason why personality studies look out for stable behavior which in turn brings out organized traits. In summary, a set of characteristics can explain criminal traits.

 I have no doubt that people pick the circumstances, which they find themselves in. Therefore, situations are as a result of premeditations, discernments and attitudes impacted by personality traits. Muncie, (2014) holds the same sentiments and agreed that previous experiences affect thoughts, which then molds a person. However, a person’s personality encourages or affects present judgements and constructs the circumstances he or she will practice in the near future. My thoughts goes hand in hand with social learning theories. Social learning theories suggest that the multifaceted approach adopted for studying personality traits was due to collaboration between a person’s prior knowledge and the immediate surroundings. From this social and intellectual point of view, acquisition of information and characteristics rely on a person’s perceptions of the human society and their personal familiarities. Personal traits and responses emerge due to both imitating other people’s traits and from behaviors observed in past encounters hence cementing personality. In other words, criminal traits arise from interactions with similar behavior in past situations. Hence, environmental features inclusive of social interactions with other people both enable and hinder formation of criminal characteristics.

To dig deeper into the topic, I hold the opinion that criminal personality researches did not last for long, in the past twenty five years because personality tests and other procedures used for studies change over time consequently leading to varying results. No single methodology stood the test of time and remains relevant for use as time progressed (Moffitt, 2017). More so, many scholars are of the opinion that criminals are less intelligent compared to the non-criminal community members. Evaluating findings from previous researches unveils the absence of relating criminal behavior with criminal activities through methodologies utilized. For instance, most researches draw their evidence from prison hence building findings from a biased point of view rather than from a neutral basis. Secondly, researchers assume inmates possess the same character due to their criminal behavior. Criminal are not people with poor behavior and it is hard associating specific traits with criminals.

White Matter Abnormalities

Psychopathy is a personality illness characterized by absence of compassion and impulsive antisocial character. Psychopathic features occur partly as a result of a functionality mishap between various parts of the brain. Findings from researches conducted by Vermeij et.al, (2017) suggested that white matter abnormalities located in temporal and fronto temporal areas might be the reason relational or social discrepancies of psychopathy in perpetrators who possess serious impulse control challenges. Hence, scientists looked further into the correlation between psychopathy and a disrupted brain connectivity and discovered that lawbreakers with psychopathic predispositions are more likely to repeat a crime than their counter parts without such an abnormality.

            The unsettling brain connections may result into psychopathic traits among criminals with impulsive regulation difficulties. This connection marked a milestone toward obtaining accurate information while studying and categorizing criminals in terms of the offenses committed (Vermeij et.al, 2017). Even more critical to note is the beneficial advantage of gauging psychopathic behavior in time and assisting in forensic evaluations tailoring intervention measures based on psychopathic data from related researches.

Psychopathy is one of the most persistent personality disorders characterized with brutality and lack of sorrow or guilt (Zimak, Suhr, & Bolinger, 2014). Theories related to psychopathy changed over time from unitary to multifaceted conditions with different subtypes that differ from each other in regards to personality traits.

Law Enforcement Strategies

  Mentally impaired offenders need a separate system from the standard one. For example, their forensic testing, assessment and management layers differently from the typical one (Zimak, Suhr, & Bolinger, 2014). In fact, the system is more complicated and needs the assistance of a psychiatrist on standby to give an accurate evaluation into the mind of the criminal. Coupled with a psychiatrist and a psychologist, extensive work goes into guiding the officers through information derived from such criminals. Therefore, an effective plan needs to factor in a specialty such as psychiatrists and psychologists as valuable resources. The criminal procedure is another factor that needs a lot of consideration when trying to implement a plan that will handle mental decreased criminals. The impaired psychological act of 2003 caters for procedures that handle cases in such contexts. The bill determines if an individual is fit to stand trial or not in court hence examining personality traits together with a well-informed judicial system leads to reduced crime rate.

 In summary, past researches proved the connection between criminal activity and personality traits. Personality traits affect activities people engage in. Prior knowledge coupled with experiences has a tendency of affecting behavior. If a person grew up in a violent surrounding he or she is likely to pick up violent traits. Mental disorders can trigger deviant traits such as aggressiveness and push individuals toward a life of crime. Hence, is necessary for the justice system to separate offenders based on mental disorders.

Reference

Edwards, B. G., Albertson, E., & Verona, E. (2017). Dark and vulnerable personality trait correlates of dimensions of criminal behavior among adult offenders. American Psychological Association, 126(7), 921–927.

Krueger, R. F., Schmutte, P. S., Caspi, A., Moffitt, T. E., Campbell, K., & Silva, P. A. (1994). Personality traits are linked to crime amongmen and women: evidence from a birth cohort. Journal of Abnormal Psychology, 103(2), 328-338.

Moffitt, T. E. (2017). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. In Biosocial Theories of Crime (pp. 69-96). Routledge.

Muncie, J. (2014). Youth and crime. Sage.

Polaschek, D. L. (2014). Adult criminals with psychopathy: Common beliefs about treatability and change have little empirical support. Current Directions in Psychological Science, 23(4), 296-301.

Schuessler, K. P., & Cressey, D. R. (1950). Personality characteristics of criminals. American Journal of Sociology, 55(5), 476-484.

Smith, S. T., Edens, J. F., Clark, J., & Rulseh, A. (2014). “So, what is a psychopath?” Venireperson perceptions, beliefs, and attitudes about psychopathic personality. Law and human behavior, 38(5), 490.

Sudhinta, S. (2016). Personality correlates of criminals: A comparative study between normal controls and criminals. Industrial Psychiatry Journal, 25(1), 1-7.

Vermeij, A., Kempes, M. M., Cima, M. J., & Mars, R. B. (2018). Affective traits of psychopathy are linked to white-matter abnormalities in impulsive male offenders. American Psychological Association, 735-745.

Zimak, E. H., Suhr, J., & Bolinger, E. M. (2014). Psychophysiological and neuropsychological characteristics of non-incarcerated adult males with higher levels of psychopathic personality traits. Journal of Psychopathology and Behavioral Assessment, 36(4), 542-554.

Managing schizophrenia

Introduction

            The management and care of people living with schizophrenia has greatly improved over the years as different medical institutions and caregivers seek out better ways to help patients manage their condition. Despite all these developments however, there is need for more research and policies that will not only help patients manage the schizophrenia, but also live independently and have fulfilled lives even with their condition. This is especially because patients have to undergo psychosocial therapy as well as rely on antipsychotic medication to help manage their condition. Since patients are known to find difficulty in adhering to the medication regiments recommended by their caregivers, the chances of relapse are high as patients may not be in the best position to manage their condition on their own and thus affects the quality of life they live. There is therefore a need for educators, caregivers and policy makers to not only come up with ways to help patients better manage their condition, but also inform the general public, families and friends about their role in helping people with schizophrenia to not just manage their condition but also have meaningful, healthy and fulfilling lives.

Background of the issue

            About one percent of the population in the United States suffers from schizophrenia (Arango et al, 2014). Even though the exact cause for the condition is still unknown, research suggests that schizophrenia results from various factors such as the neural components, genetics and even the environment in which an environment lives in. while there is no cure for the condition, antipsychotic drugs have had great success especially in reducing acute psychotic episodes. Long term therapy has also had a significant impact in reducing relapses and suicidal tendencies among patients (Arango et al, 2014). The available medication and treatment methods have had little success in treating the cognitive impairment caused by the disease. Since the impairment affects the patient’s social functions, it makes it even difficult for patients to manage their condition especially because of the stereotypes that result in schizophrenia patients being secluded or forces them to distance themselves from the general public.

            The routine activities that health services undertake to help schizophrenic patients manage their conditions combined with education about schizophrenia aimed at creating awareness could have a significant impact in helping to reduce the negative perceptions that people have towards people with schizophrenia (Buckley, 2016). It can also help to reduce the discrimination and prejudice patients face on a daily basis and this could have a huge impact in gaining the much needed support for patients in society. This is especially because the psychological interventions and support from caregivers, family and the community in general could reduce the chances of relapse by 20 percent (Arango et al, 2014). The intervention of peer groups and society in general helps schizophrenia patients lead better lives as they are welcomed into society and helped to manage their condition without being discriminated against. They therefore lead healthier and quality lives but in order for this to happen, policy makers and members of the community need to create more awareness on schizophrenia as well as the role that each member of the community plays in helping patients to manage their condition.

Background jurisdiction of the problem

            People with schizophrenia die 20 years earlier than people without the condition (Mahone et al, 2016). The high death rate is attributed to the under diagnosis and lack of adequate treatment mainly due to the patients inability to manage their condition and also failure to treat other physical illnesses associated with the condition. It is therefore important to create an integrated care package that informs the patients as well as caregivers and the general public regarding the physical and mental needs that could help schizophrenia patients to be in better control of their condition (Baldwin, 2016). This will be highly effective in creating awareness especially because people still do not understand how to manage patients with schizophrenia. The discrimination against people with schizophrenia is evident in the employment sector where only 20 percent of schizophrenia patients have competitive jobs while most of them remain unemployed (Maphis et al, 2016). It is also estimated that a third of the homeless people in the U.S have schizophrenia and cannot access the care needed to manage their condition. There is therefore a need for political action and changes in the health care industry to come up with ways to not only help patients manage their condition but also to ensure that they lead healthier and more productive lives as this will greatly increase the quality and length of life lived.

Social, legal and political factors

            Although society has had positive improvements in the way people treat those with schizophrenia, patients still tend to be isolated from society and face some forms of discrimination and prejudice that prevent them from leading productive lives (Chaves et al, 2017). The discrimination makes it difficult for people with schizophrenia to get the help they need because they are afraid of other people’s attitudes. They also tend to lose their jobs more often and are often accused of various crimes by the criminal justice system solely because of their condition. Other than the patients, schizophrenia also affects immediate family members who have to take care of the patients (Chavez et al, 2017). The toll of looking after patients with the mental illness may be too much for family members whose social life gets affected because of the burden involved in looking after schizophrenia patients. Most of the time and resources are dedicated to taking care of the patient and thus leaving little for managing a social life.

In relation to legal and political factors, the attitudes and policies put in place make it even more difficult for people with schizophrenia to get the help they need. A good example is the law that prevents people with mental illnesses from being treated involuntarily unless they pose immediate danger to others or to themselves (Asenlof et al, 2014). The law was put in place to prevent mental patients from being held in hospitals longer than necessary. While it serves a positive role in reducing time spent in psychiatric institutions, it makes it hard for mental patients to get the help they need especially in a case where the family is unwilling to seek out appropriate help for schizophrenic patients until after some serious harm has been caused or experienced by the patient as a result of their condition. The law therefore acts as a legal barrier that prevents patients from getting help in the early stages of the condition when symptoms are easier to manage.

In addition, mental illnesses like schizophrenia affect the part of the brain responsible for making rational decisions. As such, the brain cannot function properly and patients may not even know that they have schizophrenia or what they are required to do in order to keep the condition in check. With laws prohibiting involuntary treatment, the decision to seek medical help therefore lies in the hands of the patient or family members who may not be aware of the condition the patient is in (Asenlof et al, 2014). Since policies are often made on political grounds, the laws are often focused on doing what is right in the eyes of society rather than what is right for the patient. It therefore becomes hard to give patients the care they need because the decision is left to people who lack sufficient information on what to do in order to ensure that people with schizophrenia get the help they need.

Stakeholders’ role

            Stakeholders can have a positive impact in helping create awareness on how to manage schizophrenia. To begin with, they can help develop a care package to be given to people with schizophrenia bearing information on their condition and what they can do to ensure they lead productive lives despite their condition (Goldman et al, 2016). Caregivers should be encouraged to give the care package to patients and guide them on how to go about implementing it so as to manage the schizophrenia. Stakeholders should also ensure that schizophrenia patients are not alienated by society and make them part of the community by giving them jobs and active roles in the community. Sharing information regarding how to take care of such patients will ensure that they get the help they need to manage their condition without it causing major disruptions to their daily lives.

            In addition, stakeholders can also provide support for more research on schizophrenia so as to create awareness as well as come up with better and more effective treatment methods to help patients. The information will put caregivers and medical practitioners in a better position to help people with schizophrenia as they have the knowledge needed to combat negative symptoms and challenges brought about by schizophrenia (Goldman et al, 2016). There is also the need to provide adequate funds in support of ongoing campaigns as well as starting new ones. The campaigns are ideal in not just getting people to know about schizophrenia but also doing away with stereotypes that lead to the development of negative attitudes towards people with schizophrenia. Other than supporting research and development projects aimed at treating or managing schizophrenia, stakeholders also bear the responsibility of ensuring that patients are not discriminated against and that members of the society do not make it difficult for people with schizophrenia to lead normal lives despite their condition.

Policy options and alternatives

            Since seclusion from other members of the community makes it even harder for patients to manage their condition, helping schizophrenia patients to secure employment and benefit from their work will greatly increase the quality of life they live. Instead of just providing ways to manage the schizophrenia, caregivers can come up with ways to help patients fit in not only in the community but also in their places of work (Asenlof et al, 2014). The work relationship will help other employees to view people with schizophrenia as productive members of the community and not just sick people who need care. Another option that can be considered is educating family members and caregivers on how to help people with schizophrenia in ways that cause the least disruptions to their lives. At present, a lot of attention is given to helping patients manage their condition and little research discusses the impact that schizophrenia has on family members and other caregivers (Asenlof et al, 2014). Taking care of people with schizophrenia not only affects the patients’ lives but also that of the caregiver because they have to find time to take care of the patient’s needs. It is therefore important to come up with ways to help caregivers take on the added role without causing a lot of changes in both theirs and the patients’ lives.

            Another approach can be the development and implementation of awareness campaigns that are well funded and determined to not only create awareness, but also push for more research on how to manage, or even cure schizophrenia. The campaigns can get members of the community to work together towards making the lives of people with schizophrenia more productive and in so doing, improve the quality of life (Asenlof et al, 2014). They can also lead to the development of new approaches towards managing the condition and even treating it in future. Through such campaigns, people will be more informed on what schizophrenia is, how it affects patients and what needs to be done in order to manage it. The campaign will also create awareness on the importance of updating and revising policies aimed at helping people with schizophrenia so as to ensure that the policies do more to help rather than being restrictions and barriers to offering people with schizophrenia the help they need to lead productive lives.

Conclusion

            The management of schizophrenia is greatly challenged by the attitude that people have towards people living with the condition. Although patients need assistance in some aspects of their lives, people living with schizophrenia can manage their condition and remain productive members of the community. Instead of excluding them from productive activities such as denying them work opportunities, people need to help ensure that schizophrenia patients lead healthy lives by making them part of the community. Involving them in activities will create an environment where people have a better understanding of what schizophrenia is as well as the role that caregivers, family and friends play in managing it. Instead of just prescribing medical treatments, it is important to spread awareness and in so doing, involve the patients as well as society in helping to manage schizophrenia.

References

Baldwin L, (201) “Mental illness, politics and guns” Psycology Today, retrieved from,             https://www.psychologytoday.com/us/blog/beyond-schizophrenia/201606/mental-illness-  politics-and-guns

Buckley, P. F. (2016). Schizophrenia: Advances and current management.

Cecilia Rastad, Cathrin Martin, Pernilla Åsenlöf; (2014), “Barriers, Benefits, and Strategies for    Physical Activity in Patients With Schizophrenia”, Physical Therapy,           https://doi.org/10.2522/ptj.20120443

Chaves C, Pereira A, and Pinho G, (2017) Nursing interventions in schizophrenia: the       importance of therapeutic relationship. Nurse Care Open Acces Journal, retrieved from,             https://medcraveonline.com/NCOAJ/NCOAJ-03-00090.

Fleischhacker, W. W., Arango, C., Arteel, P., Barnes, T. R., Carpenter, W., Duckworth, K.,          Galderisi, S., Halpern, L., Knapp, M., Marder, S. R., Moller, M., Sartorius, N., …           Woodruff, P. (2014). Schizophrenia--time to commit to policy change. Schizophrenia      bulletin, 40 Suppl 3(Suppl 3), S165-94.

Janicak, P. G., In Marder, S. R., In Tandon, R., & In Goldman, M. (2014). Schizophrenia: Recent             in diagnosis and treatment.

Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses         Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery. Issues            in mental health nursing, 37(5), 372-9.

 Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

• Assess the information for areas of improved reimbursement of at least 20% or more.

            In most cases, family physicians end up losing at least 20 percent or more of their reimbursements annually just because of poor or incorrect coding. The reason for that is not because health care organizations are not doing their work as required. One of the factors that cause this problem to persist is because physicians do not document and code the work they do properly (Deeken et al., 2018). As a result of that, one area for improved reimbursement is studying the CPT manual as well as documentation procedures needed to enhance effective E/M (evaluation and management) services. In other words, it means that a certain percentage of family members end up ender-coding just because of underestimating the value of the health care services they offer on a daily basis (Whedon et al., 2017). Other take conservative approaches deliberately with the motive of avoiding state audit.

            According to CPT, the percentage of the 99214 codes has the potential of becoming higher as compared to other codes. For instance, the research that was initially conducted comparing the choice of codes used by family physicians with those chosen by experienced coders revealed that such physicians end up under-coding one-third of the initial established patient visits (Klann et al., 2015).  In order to in the position of billing for the level four established patient visits, the guidelines provided by the current procedural terminology (CPT) demands that two out of three of its components to be fulfilled. These components include a detailed physical exam, detailed history, and a clear clinical decision-making method of moderate complexity (Venkat et al., 2015).

            Nevertheless, in the process of assessing the information that will assist in determining the areas of improved reimbursement, it is important to bill for the CPT code 99214 revisiting without having documenting or counting personal body systems or comprehensive examination elements.  The reason for that is because clinical decision-making and history indicate that high level of complexity exists. In this case, some of the examples dealing with moderately complicated decision-making process include a request for personal consultation, an order for X-rays or laboratory texts, or a new diagnosis with prescriptions. Therefore, when it is compulsory to verify that the family of physicians had managed to perform complete system evaluation to validate a 99214 claim, historical forms, which are always filled at the waiting room before being assessed with the patient, might be a valuable time-saver ((Venkat et al., 2015).

            Nonetheless, systematic data collection is important when it comes to the need of justifying the high level code, that is suitable when new patients presents complex clinical history demanding fresh diagnosis, specialty evaluation, and new medication. It is vital to be informed about the tendency of coding the patients’ visits based on the intricacy of the clinical analysis rather than on the degree of the clinical decision-making procedure involved (Klann et al., 2015).  For instance, family physicians might be aware of the patient who visits their medical facility for annual health care maintenance examinations, then desire to discuss his or her chronic chest pain or depression. In such a situation, the family physicians might be justified to bill both office visit and preventive clinical services using a certain modifier. This is what will assist in indicating that they had managed to provide outstanding separate services (Imbery et al., 2018).

            It is important to have the ability of separating the procedure to be followed from the evaluation and management services to be offered. For instance, in case the chronic or acute problem that the family physicians evaluates is relatively stable as well as closely associated to the preventive exam-for example properly managed asthma that do not require change in treatment, then presenting an evaluation and management code is not necessary (Whedon et al., 2017). Proper documentation will, of course, take into account the need of including the main complaints, assessment, diagnosis, as well as the medication plan. It is also vital to describe fully the developing nature of the E/M services so as to assist in justifying its billing. Despite that, it has been realized that Medicaid and Medicare often end up bundling emergency services together with other associated health care medical services. This is what makes third party payers to respond in a different way (Venkat et al., 2015). Therefore, taking into account the payers’ policy, billing for either level four or level five evaluation and management visit can be a more valuable option.

            The CPT and the billing services suggest that at least all Medicare beneficiaries are entitled to receive the ‘Welcome to Medicare’ examinations within six months after enrolling into such a program. This program comprises of various components and for the sake of reimbursement, they must all be presented. Equally, to be in the position of appropriately conducting and billing for this examination, it is important to develop a template that lists all the requisite components. An example of this listing should take into account a complete reviewing the social, medical, and family history of the patient (Jones et al., 2016). At the same time, it is important to the patient’s risk factors causing depression before reviewing his or her level of securing of functional ability.

            Consequently, through basing our analysis on the patient’s physical examination, it is vital to ensure that brief explanation, counseling, or education have been provided for the sake of assisting addressing any issue or issues that might have evolved during the provision E/M service, or preventive services and its associated billing exercise. Despite that, evidence obtained from CPT services indicates that a large percentage of patients end up presenting several diagnoses that are in return addressed at any time they make routinely office visit (Imbery et al., 2018).  It is possible to utilize them in billing for the services that could have been provided. As a result of that, selecting the main diagnosis for both coding and billing before listing them with their order of their importance enables third-party payers to have the ability of prioritizing patient health care. In return, it becomes possible for a person to evaluate whether he or she has been reimbursed accordingly. It is also vital to take time and list acute and active clinical conditions that were initially discussed on the counter form during the office visit (Jinjie et al., 2017).

• Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues

            In order to be in the position of obtaining excellent value for any investment that a person make in health care, important decisions have evolved to highlight the best means of aligning health and economic incentives to realize these goals. Basing our focus on health care providers, it is important to scrutinize the significance of the existing fee-for-service reimbursement method. Often, when such incentives health and economic incentives are placed on volume and not on value, the truth is that the fee-for-service will not have the potential of creating incentives for care coordination and preventive care among providers (Jones et al., 2016).  Taking into account the number of hours physicians spend per week interacting with their health care plans, the administrative complexity developed by several documentations requirements to precertification, credentialing forms, and varying billing take time away from medical health care.   The failure to clearly distinguish the benefits and values of alternative medical attention, health care providers, and health plans is the one that ends up obfuscating the signals to potential customers (Whedon et al., 2017).

            In most cases, the time a physician spends with the patient or patients is ultimately vital for improving the quality of the health care services offered as compared to coding. For improved reimbursement, there is the need of focusing on how to collect historical information, the type of history to be performed, the type of examination to be performed, as well as the extent of clinical decision-making involved. The reason for that is because there are situations, for instance, counseling and health care coordination, in which time is greatly taken into consideration for coding purposes (Jinjie et al., 2017). In case a physician dedicates more time to coordinates care or counsel with the patient’s family or the patient as compared to the time he or she spends in handling office visit, it means that the total time consumed is the one can assist in determining the level of service. In an office, face-to-face time is the one that counts while when in the nursing home or hospital, the time consumed reviewing clinical records, interacting with nurses, and talking with patients or patients’ family is what counts (Khan et al., 2018).

            It should be remembered that counseling for evaluation and management services entail arranging a dialogue with the patients’ family or the patients themselves about several issues. Some of the issues to be discussed include things like recommended tests, benefits or risks of medication, diagnostic results, instructions for follow-up or management, prognosis, patient education, the importance of compliance, and so on. All these issues do not take into account individual psychotherapy.   According to current procedural terminology (CPT), despite that consultation might be requested by non-health care medical practitioner, for instance, psychologist, it is important to ensure that they have been executed and recorded in the physician’s note (Wei et al., 2017). In case the physician is executing consultations in his or her office, it is vital to give feedback to the physician who might have requested it through sending a letter.

            Despite the fact that the family of physicians ends up engaging in several consultations, they do not code for the myriad of consultations they make. As compared to routine initial clinical health care codes, everyday office visits or following clinical care codes, consultations usually reimburse much higher. Therefore, any request the physician may receive, either verbal or written, from another medical practitioner to examine the patient or to participate administering treatment and to return the report is all about consultation (Traynor, 2013). As a result of that, it is important for the physician to document it in his or her note in case he or she desires to code it later.

             Moreover, the majority of the medical guidelines point out that the Medicare patient ought to ensure that they have annual records regarding their reimbursement.  Despite that, it should be noted that annual physical are some of the services that are not covered by Medicare hence having nothing to do with its schedule. If a person has the ability of coding properly, it is possible to alter what you could have charged the Medicare patients as compared to that which could have been charged for non-Medicare patients for the physical exam (Khan et al., 2018). Since Medicare patients ultimately have several chronic conditions which require systematic follow-ups, it is important to submit preventive clinical services code.

            In some situations, the family physicians often do handle concurrent health care, particularly when offering subsequent clinical care that occurs when the evaluation and management services are offered at the same time by two physicians. In this case, it is important to seek the help of the physician to assist in coding the initial consultation as well as offer a subsequent clinical care code. Although it might be possible to be served by two physicians who will be coding for succeeding clinical care, whoever gets paid first, after sending the claim to the payer, will deserve it (Wei et al., 2017). It is, therefore, important to ensure that the insurance office has been notified to electronically submit that claim that same day for the service received.

• Propose a best strategy with justification and rationale based on effective decision-making tenets.

            In our contemporary health care industry, it has been realized that the existence of few non-clinical issues are the ones that have ended up creating several controversies as the CPT codes for E/M (evaluation and management) as well as the associated documentation guidelines.  As a result of that, they have managed to spur the cottage industry of cheat sheets, templates, toolkits, and scorecards. All of them are designed for the purpose of assisting a person to ascertain that his or her medical records have the documents required to support the codes selected (Jones et al., 2016).

            The CPT 99214 code as the established patient visit is one of the evolving detailed examination, detailed history, as well as a therapeutic decision-making protocol of moderate complexity.  Since coding is based on the history and the decision making, it implies that it gives a person an ample time of counting body systems or examination elements so as to validate the reported health care level. It is easy to recognize high-complexity or straightforward encounters, but low and moderate levels of decision-making often become ambiguous. As a result of that, it is important to regard decision-making as some of the means that can be used to enhance comparative analysis when reimbursement is to be made (Whedon et al., 2017).

            Nevertheless, in the process of determining the clinical decision-making procedure; it is important to consider understanding the seriousness of the problem at hand, or the extent of the differential diagnosis made. When family physicians are handling several medical problems, having an increased level of uncertainty, or having multiple data element to be reviewed, it is paramount to regard the clinical decision-making process as being a moderate exercise (Imbery et al., 2018). For instance, this could be a patient suffering from three stable diseases and who is being managed on prescribed drugs.

            The available evidence indicates that even if billing for problem-oriented and preventive health care is systematically done and documentation and the associated codes are submitted, a person may fail to be reimbursed for the two. Some third-party payers have the likelihood of paying a certain amount of each while other might decline incurring the extra claim completely. Conversely, there exist some health care plans that necessitate a patient who produces two charges in a day to pay two separate co-pays (Traynor, 2013). Because of that, chances are that one can have the opportunity of using higher level evaluation and management codes that are entirely based on time, despite of the complexities of the clinical history, decision-making, or physical examinations

            With the presence of personal plans aimed at maximizing the reimbursement of dermatologic procedures, it is important to be aware of the terms to use as well as the descriptive details to be recorded. The reason for that is because making use of the right terminology is the one that will assist in ensuring that he or she have been properly reimbursed for any procedure he or she might have performed. Additionally, CPT evidence suggests that what is not always factored into the compensation or reimbursement formula is the margins of the shaved lesion. It is, therefore, important to ensure that it is only the measurement of the lesion that has been documented (Deeken et al., 2018). The location of the ailment also assists in dictating the level of reimbursement that is usually lower for some of the procedures done on the arms, trunk, or legs as compared to those done in anogenital area or on the face.

            Thus, the CPT codes or the E/M codes that aid in describing are mainly used for the purpose of charging office encounter with an established patient or patients. As stated above, the majority of physicians end up under-coding chronically for the health care services that they offer just because they do not understand or underestimate the rules. Therefore, taking into account the working understanding of the evaluation and management coding is perceived to be the ultimate means of ensuring optimal conformity and avoidance of inadvertent under-coding (Traynor, 2013). On the other hand, family physicians who have the ability of understanding the idiosyncratic processes of the E/M recording can have the opportunity of commanding high return rates on their cognitive work as compared to E/M-savvy physicians or counterparts. This is to imply that for those physicians who clearly understand how to bill for the services they offer accurately, they have higher chances of getting paid for what they do.

            Last, but not least, to have the propensity of supporting the consultation or office visit code, it is the responsibility of the physician to ensure that he or she has had the chance of airing their views concerning a certain problem. This is to imply that the requests to be made can either be recommending health care for a certain problem or condition or determining whether to acknowledge responsibility for the current management of the health care (Khan et al., 2018). It is also important to make thorough checks the third-party payers to assist in ascertaining whether consultation codes are regarded as being the ultimate means for billing. This means that, in the place of the consultation codes, for instance, the CPT 99214s code, it is important for family physicians to ensure that they have used newer patient codes for all the services they could have executed in their respective office or in other outdoor facilities (Deeken et al., 2018). It is this guideline that will assist in boosting effective decision-making tenets.

                                                            References

Deeken-Draisey, A., Ritchie, A., Yang, G.-Y., Quinn, M., Ernst, L. M., Guttormsen, A., … Maniar, K. P. (2018). Current Procedural Terminology Coding for Surgical Pathology: A Review and One Academic Center’s Experience With Pathologist-Verified Coding. Archives of Pathology & Laboratory Medicine, (12), 1524. https://doi.org/10.5858/arpa.2017-0190-RA

Imbery, T. E., Nicholas, B. D., & Goyal, P. (2018). Analyzing Medicare payments to otologists. ENT: Ear, Nose & Throat Journal, 97(7), 208–212. https://doi.org/10.1177/014556131809700711

Jinjie Huang, Tattersall, R., Morse, K., Nickerson-Troy, J., Clements, E., Celauro, L., & Lovell, A. (2017). Assessment of reimbursement in a community hospital--based pharmacist-managed outpatient transition clinic. American Journal of Health-System Pharmacy, 74, S30–S34. https://doi.org/10.2146/ajhp160428

Jones, C. A., Acevedo, J., Bull, J., & Kamal, A. H. (2016). Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond. Journal of Palliative Medicine, 19(12), 1249–1253. https://doi.org/10.1089/jpm.2016.0202

Khan, A., Massey, B., Rao, S., & Pandolfino, J. (2018). Esophageal function testing: Billing and coding update. Neurogastroenterology and Motility, (1). https://doi.org/10.1111/nmo.13158

Klann, J. G., Phillips, L. C., Turchin, A., Weiler, S., Mandl, K. D., & Murphy, S. N. (2015). A numerical similarity approach for using retired Current Procedural Terminology (CPT) codes for electronic phenotyping in the Scalable Collaborative Infrastructure for a Learning Health System (SCILHS). https://doi.org/10.1186/s12911-015-0223-x

Traynor, K. (2013). Transitional care CPT codes may include pharmacists’ services. American Journal of Health-System Pharmacy, (9), 748. https://doi.org/10.2146/news130034

Venkat, A., Kekre, S., Hegde, G. G., Shang, J., & Campbell, T. P. (2015). Strategic Management of Operations in the Emergency Department. Production & Operations Management, 24(11), 1706–1723. https://doi.org/10.1111/poms.12346

Wei, W.-Q., Bastarache, L. A., Carroll, R. J., Marlo, J. E., Osterman, T. J., Gamazon, E. R., … Denny, J. C. (2017). Evaluating phecodes, clinical classification software, and ICD-9-CM codes for phenome-wide association studies in the electronic health record. PLoS ONE, (7). https://doi.org/10.1371/journal.pone.0175508

Whedon, J., Tosteson, T. D., Kizhakkeveettil, A., & Kimura, M. N. (2017). Insurance Reimbursement for Complementary Healthcare Services. Journal of Alternative & Complementary Medicine, 23(4), 264. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3dedb%26AN%3d122401274%26site%3deds-live

                                                            Appendix

• Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).

Reimbursement from the Centers for Medicare and Medicaid Services =

            40% Medicare = (40/100) x $2,054,197,206

                                    = 0.4 x $2,054,197,206

                                    =$821,678,882

            10% Medicaid = (10/100) x$ 654, 8764,000

                                    = $ 0.1 x$ 654, 864,000

                                    =$ 65,486,400

• Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).

            10% Medicaid = (10/100) x$ 987,650,100

                                    = 0.1 x$ 987,650,100

                                    =$ 98,765,010

• Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.

                        Traditional indemnity insurance = (25/100x) $ 53, 210, 720

                                                                             = 0.25 x$ 53, 210, 720

                                                                           = $ 133,026,800

• Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.

     Disabilities Research Paper: Visual Impairment in Young Children

Change management

Introduction

            People’s health behaviors have a major impact on their ability to prevent and manage the various medical conditions that human beings face on a daily basis. It is therefore important for individuals to learn how their behaviors affect their overall health and what can be done to prevent health problems such as obesity or how to manage and even treat them when they occur. The management of obesity is of great importance not only because of the alarming numbers of obese people but also due to the complexity that is involved in managing the condition. According to the World Health Organization, about 13 percent of adults in the world are obese and 39 percent are overweight (Marques & Teixeira, 2018). Obesity and overweight adults face various medical challenges and a lot of medical cost is incurred in helping such individuals to manage their condition and lose weight. Although managing and reducing obesity is a complex task, it is something that can be achieved through the implementation of the stages of change model or the trans-theoretical model.

Overview

            The stages of change theory, or trans-theoretical model, was introduced by Carlo DiClemente and James Prochaska in the 1970’s as they sought different ways in which they could help people stop smoking (Cohn & Russel, 2012). Although the theory first sought to stop smoking, it led to better understanding of the various behavioral changes that people go through as well as what can be done to bring about positive behavioral change. The theory is based on the assumption that when people go through life long changes, the change is often gradual and relapsing is often part of the process. The relapses are explained by people’s tendency to resist or unwillingness to accept change especially in the first stages of the change process (Cooper et al, 2018). However, if individuals are committed and remain proactive in their attempt to change a specific behavior, it is possible to change personal behaviors that promote medical issues such as obesity.

            The first stage in the stages of change model is the pre-contemplation stage which is characterized by denial as people are yet to identify that their behavior is causing problems for their overall health. As a result, people do not consider making any changes because they either fail to see the need to change their behavior or have no idea the impact that changing behavior could have on their health (Mulholand, 2017). In the case of people with diabetes, the pre-contemplation stage is crucial as it calls attention to the risk that the individuals put on themselves with the decisions they make and how their behavior has led to issues of overweight and obesity.  Pre-contemplation is followed by contemplation which is the stage in which people learn how their behaviors affect their health and what changes can be done to improve their overall health. Although people are more aware of the impact their actions and decisions have on their health, it is also the stage that people learn of the sacrifices, cost and changes that they will be required to make in order to bring about the desired change (Crowe Associates, 2018). As a result, most people fail to move past the contemplation stage because of all the work and changes that are required. In the case of people with diabetes, the contemplation stage is when the individuals learn of the harm that their diets have on their health, the importance of exercise and other elements that may be too challenging to take on without proper motivation.

            The third stage in the model is the preparation stage where people start making significant changes to their behavior with the aim of achieving a larger and more permanent change. For obese individuals, the preparation stage involves switching to lower fat foods, exercise and seeking professional advice to mention a few (Cherry, 2018). In this stage, individuals seek advice from professionals like nutritionists, enrolling in health clubs, buying workout equipment, change in diets among other activities aimed to help in reducing weight. The preparation stage is therefore an information seeking stage which equips the individual with all the information required to bring about the desired change.

            After preparation, the model moves on to the action stage where people are actively involved to achieve the goals set in the preparation stage. Obese individuals take actions such as eating healthier diets, engaging in physical activities and other forms of behavior aimed at cutting down weight. It is however important that individuals remain consistent with the planned set of actions set out to achieve a specific goal (Cherry, 2018). It is therefore important for trainers and medical professionals to keep motivating individuals to continue with the routines so as to have permanent results. Individuals should also come up with ways to motivate themselves so as to make the change more bearable and reduce the likelihood to quit half way through the process.

            Once a positive change has been achieved, the next stage is to maintain the change so as to prevent the individual from going back to previous behaviors. At this stage, individuals are more confident in their ability to continue implementing the changes and are more determined to succeed. Obese people in this stage are more determined to get rid of any temptations that could trigger old habits (Cherry, 2018). By this time, the change has already started to take form and people are more aware of how their personal behavior and actions affect their health. They are also aware of what changes need to be made and what behavior needs to be maintained in order to achieve the goal set in the preparation stage in order to have good health. Although people in the maintenance stage are determined to maintain the positive change in their life, there is the final stage which is relapse where people may revert to old habits (Cherry, 2018). This often occurs when the change becomes too much or when individuals get tempted to revert back to their old habits. Although detrimental, relapse stage is common and people should not doubt their ability to change in case a relapse occurs. Instead, individuals should go back through the process and redefine their objectives again so as to have better control over the changes that come about and in so doing, maintain good health.

Strengths

            The trans-theoretical model has various advantages, one of which is its ability to make people more aware about how their behavior affects their health. The stages help people get from a place of denial to one where they better understand the risks that their behaviors pose and what they can do to not only manage medical conditions like diabetes but also how to overcome negative outcomes resulting from their past behaviors (Bennet et al, 2015). Another advantage is that, the model helps develop positive attitudes towards health behavior in the case of both positive and negative outcomes. If individuals get positive feedback after undergoing behavior changes, the model helps them to continue with the positive behaviors so as to ensure that they maintain good health. If the outcome is negative, for example during relapse, the model gives guidelines on how the individual can go back and start from the first stage with more conviction and a well laid out plan to ensure that the negative outcomes do not reoccur.

Self-liberation is another advantage whereby the model helps individuals to not only believe that achieving a healthy behavior is possible but also that it is something that they can achieve with just a few alterations to their behavior. Although some may seek professional help, the model gives most of the control to the individual and this makes it easier and more fulfilling when they meet their goals (Cherry, 2018). Through the model, people not only get to know how changing behavior promotes health but also gives them the satisfaction that they actively engaged in something that promoted their overall health. Lastly, the model is advantageous in that rewards the positive behavioral change by helping individuals lead healthier lives. In the case of people with obesity, the rewards could come in the form of lost weight and this can greatly help in reducing the challenges that come with being obese.

Weaknesses

Despite its success in bringing about behavioral change, the trans-theoretical model has various disadvantages that could affect its effectiveness. To begin with, the model fails to account for constraints that could make it difficult for people to stick to the changes they make (Bennet et al, 2015). Financial constraints for instance in cases where individuals have to change their diets and going to the gym could become too difficult and prevent the changes in behavior. The desire to change behavior and improve one’s health can therefore be challenged by the cost and other factors that may be too difficult to take on.

Another disadvantage has to do with the lack of clarity in the model on how individuals transition from one stage of the process to the next. Although the model goes into detail explaining what each stage involves, it does little to explain how to identify the end of one stage and the beginning of another (Cohn & Russel, 2012). People therefore have a hard time identifying which stage of the model they are in and this makes it difficult to determine what actions to take depending on the stages. There is also the limitation in lack of clarity regarding how much time should be spent in the specific stages. Since it is not clear how long one should stay in specific stages, people may spend too much or too little time on one stage and end up affecting the efficiency and success of the process.

Lastly, the theory is based on the assumption that people make logical and coherent plans in their decision making and will therefore see out the entire process. However, people have the tendency to deviate from their own goals and objectives especially when the results take too long or are not what was expected (Cohn & Russel, 2012). Often times, the risk to health and negative behaviors are as a result of the bad decisions that people make. In the case of obesity, some individuals may be aware that their lifestyles contribute to their poor health but still keep engaging in them because they have become a norm. assuming that people will do the right and logical thing is therefore a risk as one can never anticipate what decision people will make and the behavioral change could be ineffective especially because most of the control is given to the individual.

Brief history of the client’s problem

            The client in question has had an issue with obesity due to his eating habits. Despite having struggled with overweight issue and other problems caused by obesity, the client finds it difficult to commit to a lifestyle that will help him manage his condition. Over the years, the client has tried various methods to try and manage the obesity. Some of the solutions that he has tried include going to the gym, jogging and other physical activities in an attempt to lose weight. However, the client tends to quit any attempt to lead a healthier life because he has adjusted to a lifestyle that makes it easier to live with his obesity.

            The challenges that the client has had when trying to commit to the decision to lose weight is mainly because he lacked a systematic and detailed guide on what he can do to get the desired outcomes. If the client was to use the trans-theoretical model, he would have a system to follow and steps to take in order to manage his diabetes. This is especially because the model not only helps the client to manage the condition, but also brings about behavioral change that does away with lifestyles that promote overweight and obesity. It is therefore the most applicable model and could likely have the best outcomes if implemented appropriately.

Conclusion

            Change management has had appositive impact in helping people with different medical conditions to manage and lead healthy lives. This is especially because the change targets people’s behavior that promotes the existence and development of the medical conditions. While treating a disease is made easier by the different forms of medical treatments, change management focuses on the bigger picture and targets the individual’s behavior. In the case of obesity, helping clients change their behavior and lifestyles ensure that individuals abandon destructive eating habits and pick up activities such as physical  exercise. Change management is therefore effective because it not only helps resolve medical challenges that clients may be facing but also ensures that such challenges do not occur in future.

References

Bennet P, Dunbar J, Gillison F, Greaves C and Perry R, (2015) “Process of behavior change and weight loss in a theory based weight loss intervention program: A test of the process    model for lifestyle behavior change” International Journal of Behavioral Nutrition and Physical Activity, retrieved from,             https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-014-0160-6

Cherry K, (2018) “The 6 stages of behavior change” retrieved from,             https://www.verywellmind.com/the-stages-of-change-2794868

Cohn R and Russell J, (2012) “Transtheoretical model” Book on Demand, print

Cooper M, Epner K, Horvath T and Misra K, (2018) “Motivation for change: The stages of          change model” retrieved from,           https://www.centersite.net/poc/view_doc.php?type=doc&id=48539&cn=1408

Crowe Associates, (2018) “Behavior change theory” retrieved from, http://www.crowe-            associates.co.uk/coaching-and-mentoring-skills/1346-2/

Gillison, F., Stathi, A., Reddy, P., Perry, R., Taylor, G., Bennett, P., ... Greaves, C.            (2015). Processes of behavior change and weight loss in a theory-based weight loss        intervention program: a test of the process model for lifestyle behavior    change. International Journal of Behavioral Nutrition and Physical             Activity. https://doi.org/10.1186/s12966-014-0160-6

Mulholand B, (2017) “Eight critical change management models to evolve and survive”   retrieved from, https://www.process.st/change-management-models/

Teixeira, P. J., & Marques, M. M. (2017). Health Behavior Change for Obesity     Management. Obesity facts, 10(6), 666-673.

Presently, obesity is an epidemic all over the globe. Bariatric surgery, offers a sustainable solution to weight loss compared to other alternatives such exercising programs and dieting (Patel et.al, 2017). Like any other medical procedure, bariatric surgery has side effects relating to micro deficiencies arising from both patients’ and variables that go into the medical procedures. Furthermore, micronutrients deficiencies resulting from bariatric surgery are vitamin B12 and folate deficiencies.

How often B12 should be tested

Vitamin B12 is a vital vitamin, which performs many functions within the body. There are various ways for testing B12 (Patel et.al, 2017). One of the ways is through a blood test and urine. This deficiency is common among elderly people.

            When a patient develops vitamin B12, health care providers can administer b12 shots after bariatric surgery. Furthermore, according to past researches, oral supplementation of the B12 returns the levels back to normal after the surgery especially among patients who underwent gastric bypass (Patel et.al, 2017). Statistics reveal that an estimated 50% of patients who undergo bariatric surgery experience B12 deficiency. For example in America, this percentage is 200,000 people.

Normally, after bariatric surgery, a patient has to follow a dietary supplementation plan even before leaving the hospital bed (Patel et.al, 2017). However, B12 complications may develop later after supplementation fails.

B12 occurs naturally in meat and dairy items. It plays a crucial part in development and duplication of cells as well as normal functioning of the nervous system (Patel et.al, 2017). Daily dosage of B12 is 2.4 mg. Some of the effects associated with bariatric surgery are anemia, which consequently causes fatigue and faintness. In the end, bariatric patients have a high probability of suffering from B12 deficiency due to changing the digestive region hence disrupting normal absorption of B12 vitamin.

Reference

Patel, J., Mundi, M., Hurt, R., Wolfe, B. and Martindale, R., (2017). ‘Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals,’ Nutrition in Clinical Practice, 32(4), pp.471-480. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28609642