Tag: Clinical-Nursing

ASSESSMENT TASK 1: Case Study Part A

Answer the questions related to the information provided in the case study

Your research must be appropriately referenced using APA guidelines. The total word limit for your

responses is approximately 1,500 words (+/- 10%).

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As this unit is not directly assessed in the clinical workplace, both assessment tasks need to

reflect a simulated clinical work environment demonstrating critical thinking applied to clinical

conditions.

Case Study

William Smith is a 68 year-old man who was transferred to the Palliative Care ward three days ago

from a surgical ward. He was admitted on 26/01/2013 for excision of a sacral abscess which had

been causing him a lot of pain. After surgery his future management was assessed and it was

decided that he would be transferred to the Palliative Care ward as he could not be discharged

home.

Social History

Mr Smith lives alone in a unit with 23 stairs. He is unable to care for himself and refuses any

home help.

According to his daughter who was contacted by the Social Worker, Mr Smith has a past

history of domestic violence and abuse towards his former wife and children. His son and daughter

are finding it hard to visit him even at this end stage of his life and have stated that they are not

willing to care for him at home.

Mr Smith identifies himself as an indigenous Australian (a person of Aboriginal or Torres

Strait Islander descent). He was born in Arnhem Land but moved firstly to a rural township in the

Northern Territory before settling in his current home in a metropolitan city at age 65 to be nearer

to his estranged children.

He has a past history of alcohol abuse until his admission to hospital on 26/01/2013.

Medical History

Mr Smith has a past history of a primary Ca lung with liver and bone metastases.

He also has a past history of COPD as he was a heavy smoker ( > 20 cigs a day for 45 years).

Physical Assessment on admission

Mr Smith has dyspnoea, ascites, pruritus and bone pain (moderate to severe at times).

He is very thin as he has been anorexic for several weeks. According to a neighbour, he lived

on beer and baked beans with an occasional meal at the club when he could be taken there by a

friend.

His skin is stretched over his distended abdomen and bony prominences.

He is not able to walk unaided further than from the bed to the bedside chair.

He requires oxygen at all times.

29/01/2013 – Palliative Care Unit Admission Assessment

Mr Smith is receiving regular analgesia for pain.

He had not been ordered an aperient for several days and has not had his bowels opened

since admission to hospital on 26/01/2013 and he is feeling very uncomfortable.

He refuses to eat much as he doesn’t like the food in hospital. His fluid intake is low and he

is showing signs of possible dehydration. His urine output needs to be monitored.

Mr Smith is also complaining of stomatitis – he has poorly fitting dentures and evidence of

mouth ulcers.

 

He also suffers from hiccups which can last for 20 minutes at a time.

He is complaining of nausea and vomiting. His weight loss is marked (5kg since admission

26/01/2013).

Mr Smith can be incontinent of urine at night.

Mr Smith is finding it very hard to sleep at night and falls asleep for long periods during the day.

He has been talking a little about his children and speaks about his former behaviour

towards his wife and children with regret. He often asks if his children are going to visit him.

06/02/2013

Mr Smith has now been on the Palliative Care ward for a week. He has deteriorated in the past few days and is now bed bound.

He is able to roll from side to side for PAC.

His skin is intact apart from a small pressure ulcer (0.2 x 0.1cm) on his sacrum.

He is extremely sensitive to soap because of an increase in ascites and consequent pruritus.

He needs assistance with personal hygiene (sponge in bed).

He refuses to wear his dentures now as his mouth is extremely painful. He has been ordered

Nilstat and Bonjela (anaesthetic mouth gel) with limited effect as he doesn’t like the taste.

His breathlessness has increased and he is having 4/24 Ventolin nebs.

He is ordered soft diet, encourage fluids. Mr Smith likes ginger beer which he says helps his hiccups (next-door neighbour brought some in)

BNO for several days. Microlax enema and Agarol 10ml given with effect.

Can be incontinent of urine at times – pad in situ.

Current analgesia is oral (Oxycontin 100mg bd and Tramadol 50mg bd) – Mr Smith states

this regime is “holding pain at present”. Pain score 2 -3/10.

He can be confused and agitated at times.

Mr Smith has requested a visit from the Social Worker to try to organise a visit with his

children. He is very depressed about the current situation.

Daily TPR and BP and girth measurement.

PART A: Analyse the information given in the case study and answer the following questions. NUMBER

EACH QUESTION IN YOUR SUBMISSION

Review the following document to assist your responses to questions 1 – 2:

Queensland Health (2011) Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait

Islander people through death and dying

http://www.health.qld.gov.au/atsihealth/documents/sorry_business.pdf

 

 

 

QUESTIONS:

 

Could Mr Smith’s culture influence his pain assessment? Why? What strategies could you employ to ensure that you are adequately addressing Mr Smith’s pain?

 

2 Consider Mr Smith’s social and medical history.

Reflect on any judgements and prejudices that you may have when caring for Mr Smith.

Review the following professional Australian nursing standards:

http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

 

Code of Ethics for Nurses

Code of Professional Conduct for Nurses

EN Competency Standards

 

Outline the standards / codes that relate to non-judgemental nursing care in this situation.

 

Compile a list of questions you would ask Mr Smith as part of an holistic health assessment. These questions should be framed to enable collection of information on:

 

physical health status including pain assessment

mental and emotional status

social and cultural issues

 

Mr Smith asks you about planning for his future. He states that he does not want to be resuscitated.

 

Provide Mr Smith with a brief description (with APA referencing) of the following and apply it to this scenario:

 

Advanced Health Directive

Enduring Power of Attorney

Organ Donation

 

5: Suggest alternative strategies (complimentary therapies) other than pharmaceutical pain management that could help Mr. Smith’s pain.

 

6.List appropriate referrals for Mr Smith to other members of the multi-disciplinary team. Provide a rationale and a description of the service for each referral.

 

7: What support / referral could be offered to Mr Smith’s family?

Outline the pathophysiology of the following conditions ensuring you relate back to Mr Smith and his clinical presentation. Include within your answer the possible management strategies and rationale for these symptoms:

 

Anorexia

Ascites

Dyspnoea

Hiccups

 

Note: Pathophysiology is not signs and symptoms. Pathophysiology explains the processes within the body that result in the signs and symptoms of a disease.

 

Consider Mr Smith’s deterioration. What data provided about Mr Smith’s condition on 06/02/2013 would assist in determining if Mr Smith is at end of life?

 

Clinical Assessment of Mr. Smith’s Health Case

QUESTIONS

Could Mr Smith’s culture influence his pain assessment? Why? What strategies could you employ to ensure that you are adequately addressing Mr Smith’s pain?

Mr. Smith is a patient with a disturbing social and medical history. His social culture is such that he lives alone and does not like any person helping him out at home. These factors would interfere with his pain assessment since he would not want to reveal that he is in pain because it would mean that a caregiver would be assigned to him. One of the strategies that would ensure that I  address Mr. Smith’s pain is regular monitoring of his health condition. In this way, I will be able to know if there is any improvement in the pain therapy that is being administered.

2)  Consider Mr Smith’s social and medical history

Reflect on any judgements and prejudices that you may have when caring for Mr Smith

The social history of Mr. Smith shows that he was an abusive husband who battered his own wife and children on countless occasions. Moreover, he has a past history of alcohol addiction that could have contributed to his aggressive and brutal personality. This social vices would make a physician or caregiver to develop a negative attitude towards Mr. Smith. This is because he showed no respect or concern for his wife or children and did not play the part of a responsible father or husband. His alcohol and cigarette addiction has also largely contributed to his deteriorating state of health, something that he does not show any concern for whatsoever. When caring for Mr. Smith, I would be prejudiced to show low quality care compared to other patients due to his unhealthy habits of smoking and drinking for a person of his age.

The medical records show that Mr. Smith lived on baked beans and beer, yet he knew that it is not advisable to drink before having a healthy diet. The palliative unit care also recorded that Mr. Smith was stubborn and he refused to eat, making his body become emaciated and highly dehydrated. As a caregiver, I would be prejudiced to take care of such a patient because it would seem that they are not doing their best to get better despite being given helpful advice and care by the physicians. What’s more, Mr. Smith does not like taking any fluids which would help in rehydrating the body. A caregiver can only do as much to a patient to help them recover, but if the patient does not want to co-operate, then the caregiver would be faced with a hard time and would tend to develop a bias towards such a patient.

Review the following professional Australian nursing standards:

http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

Code of Ethics for Nurses

 
This code documents the value that nurses have towards providing quality care for all classes of people. In addition, this code affirms that nurses value kindness and respect for themselves and for others. It is the duty of nurses to value quality based health care to all people under their care. What’s more, nurses value making informed decisions that will help in preserving the value of a culture safely while still maintaining good health care. This ethical code for nurses states that nurses highly value an environment that is sustainable both socially and economically since it is capable of promoting health and well being of patients.

Code of Professional Conduct for Nurses

             
This code states that nurses should offer their services to patients in a safe and competent manner in accordance to the standards set by their professional body. Moreover, nurses are expected to respect the culture, ethnicity and dignity of the patients under their care. This includes treating any personal information with a lot of privacy and confidentiality. Nurses are also expected to preserve and promote the trust that exists between patients and health care givers. In overall, it should always be the duty of a nurse to practice nursing in an ethical and professional manner.

EN Competency Standards

             
These standards apply to all enrolled nurses and they aim at demonstrating a high level of knowledge in the law that relates to the nursing practice. Secondly, these standards require nurses to show that they have knowledge in organizational procedures and policies that closely relate to nursing. Thirdly, an enrolled  nurse should fulfill their duty of providing health care during their practice. Moreover, these standards ensure that there is a safe outcome for all groups and individuals by identifying a  situation that is likely to cause harm to others. In addition, these standards are set in such a way that they liaise with others so that the rights of all individuals are maintained properly.

Outline the standards / codes that relate to non-judgmental nursing care in this situation.

In this situation, Mr. Smith is a patient who has a past history of domestic violence towards his family. In addition, he is also an alcoholic and a heavy cigarette smoker who does not observe a proper diet. His medical records indicate that he is stubborn and he hardly eats meals and neither does he take fluids regularly. These factors would make a caregiver or nurse to become judgmental about his current health status, leading to prejudiced health care. The standard codes that relate to non-judgmental nursing care affirm that it is the duty of a nurse to provide quality care to all people. This is regardless of their social behaviors or ethnical background. Therefore, the nurse attending to Mr. Smith is expected to show no bias despite of his difficult and stubborn nature of refusing to eat or drink fluids.

3)
Compile a list of questions you would ask Mr Smith as part of a holistic health assessment These questions should be framed to enable collection of information on

Physical health status including pain assessment:

Has the level of pain reduced since you were transferred to palliative care?

Has the regular analgesia been working positively to relieve you of your pain?

Do you think that if we put you on a regular diet you would try and improve your eating habits?

Mental and emotional status:

Do you sometimes think that your past habits are to blame for the kind of pain you are experiencing today?

Do you think your hostile and aggressive nature is the reason why your children and wife do not come to visit you?

Do you sometimes think that if you had someone to talk to regularly your pain and illness would go away at a faster rate?

Social and cultural issues:

What is the reason why you indulged in a lot of alcohol consumption and chain smoking?

Does your cultural background have any connection with the various types of illness you have and does it conflict with the therapy that we propose to provide?

What is the explanation for having physically abused and battered your own wife and children?

4) Mr Smith asks you about planning for his future. He states that he does not want to be resuscitated. Provide Mr Smith with a brief description (with APA referencing) of the following and apply it to this scenario:

a) Advanced Health Directive

             
This refers to a formal way of giving instructions and advice for the future healthcare and it is only applicable if a patient is unable to make their own decisions. This directive allows a person to decide what medical treatment they would prefer should they be in a position where they cannot make their won decisions. In this scenario, Mr. Smith has already decided that he does not want to be resuscitated should he go into a cardiac arrest. The Advanced Health Directive favors Mr. Smith’s decision and nurses have no choice but to abide by his choice of treatment.

b) Enduring Power of Attorney

This is a legal agreement that enables a person to appoint an attorney who can make legal decisions on their behalf. It is an agreement that is made by choice and can be executed by any person who is above 18 years of age. In Mr. Smith’s case, the attorney he appoints has the power to oversee that no resuscitation is conducted should he go into a cardiac arrest or any other serious condition.

Organ Donation

             
This is the practice where some terminally ill patients state that they wish to give out their organs for research or to an anonymous person who is in desperate need of a major organ. Since Mr. Smith only stated that he does not wish to be resuscitated, the nurse in charge can decide whether to preserve his body after he succumbs or donate his organs for a worthy cause.

5) Suggest alternative strategies (complimentary therapies) other than pharmaceutical pain management that could help Mr. Smith’s pain

Mr. Smith’s pain is caused by a combination of various physical conditions such as bone pain, ascites, dyspnoea and pruritus. In addition to the use of drug therapy, there are other complementary therapies that are used to help patients relieve pain caused by physical illnesses. Ascites is a medical condition where the body has a build up of fluids which can occur due to cancer or other such like conditions. The complimentary therapy that can be used to relieve this pain would involve draining the fluid from the abdomen in order to relieve the swelling. This method does not involve the use of conventional drugs and can be quite effective if done professionally. For the bone pain, Mr. Smith can consider chiropractic which is a manipulation of the functioning of the spinal cord and body joints. Chiropractors work by aligning the bones and joints in order to relieve any form of pain. This is an established form of complimentary therapy that supports the use of chiropractic and spinal manipulation to treat bone, neck and back pain.

6) List appropriate referrals for Mr Smith to other members of the multi-disciplinary team. Provide a rationale and a description of the service for each referral

           
Mr. Smith is a patient who suffers from many forms of illnesses that can better be addressed by other members of the multi-disciplinary (MDT) healthcare team. To begin with, I would refer Mr. Smith to a medical oncologist to check whether he has any malignant or benign tumors. This is because ascites is mainly caused by cancer, which would be possible for Mr. Smith given his long history of tobacco smoking. Secondly, I would refer Mr. Smith to an orthopaedic surgeon who is better placed to explain the genesis of bone pain in Mr. Smith’s body. Thirdly, I would also refer Mr. Smith to a nutritionist who would help in devising the appropriate diet for Mr.Smith to enable him gain full health in the shortest time. Finally, I would also refer Mr. Smith to a psychologist to help in assessing the mental problems that cause Mr. Smith to have such wanting social behaviors.

7)What support / referral could be offered to Mr Smith’s family?

The best support that would be offered to Mr. Smith would be psychological counseling that would help them heal the scars caused by domestic violence and physical abuse of Mr. Smith. This would be the first step towards obtaining healing for all the wrongs that Mr. Smith did to this family. On the part of Mr. Smith, reconciling with his family would be beneficial to his health since he would be able to recover at a much faster rate.

8)Outline the pathophysiology of the following conditions ensuring you relate back to Mr Smith and his clinical presentation. Include within your answer the possible management strategies and rationale for these symptoms

a) Anorexia

           
The pathophysiology of this condition begins with the person having a devastating fear of adding weight. Consequently, the person does not observe a healthy eating routine and the body then begins to develop symptoms that indicate it is being deprived of necessary nutrients. For Mr. Smith, he was severely anorexic and this was manifested by symptoms such as drying of the skin, swelling of submandibular glands that caused pain to develop in his mouth and peripheral oedema that also contributed to accumulation of fluids in his body. The management strategy for anorexia is eating healthy foods so that the body is able to function properly and have the strength to fight diseases.

b) Ascites

             
This is a medical condition where the body accumulates a lot of fluids in the peritoneal cavity and is mainly caused by certain forms of  cancer. The pathophysiology of ascites is such that the rate of accumulation of body fluids is faster than the rate at which fluids are removed from the body. Mr. Smith could have developed ascites possibly due to lung cancer that would have resulted due to cigarette smoking. The possible management of this condition is drainage of the accumulated fluid so that the abdominal cavity can go back to its original size.

c)Dyspnoea

This is a medical condition where the patient suffers from an acute shortness of breath that becomes pathological if it occurs in unexpected circumstances. The pathophysiology of dyspnoea is such that the body receptors are not able to relay information appropriately. For instance, the lung muscles would be strained such that they do not stretch or relax as they should. Mr. Smith suffers from dyspnoea possibly because he is a chain smoker and the state of his lungs have been compromised. Consequently, his lungs are not well ventilated and this largely impairs the exchange of gases. The possible management strategy for this condition would be the use of opioids that will enhance the functioning of receptors in order to reduce the occurrence of shortness of breath.

Hiccups

             
This is an involuntary action that the body uses to alert an individual that the body is dehydrated. Hiccups act as warning signs to signal the person that the body is in urgent need of water. The medical records showed that Mr. Smith suffered from regular hiccups that  would last for up to 20 minutes. Hiccups are actually quite serious and can cause death if a person does not rehydrate the body by drinking water immediately. The hiccups suffered by Mr. Smith show that he was severely dehydrated and he requires to drink lots of fluids in order to ensure that his body is hydrated to the appropriate level.

9)Consider Mr Smith’s deterioration. What data provided about Mr Smith’s condition on 06/02/2013 would assist in determining if Mr Smith is at end of life?

The records on this date indicate that Mr smith is actually bedridden and all the care is given to him at his bedside. He cannot be able to shower himself and he is sponge bathed by the caregivers. Moreover, his dyspnoea has worsened and he is having 4/24 Ventolin nebs to assist with his breathing. His condition is even worsened by the fact that he takes ginger beer to treat his hiccups instead of taking normal fluids. These conditions are telltale signs that he does not have much time to live.

Dental Health PICO Essay

This paper analytically examines the issue of whether topical fluoride can be effective in the management and reduction of tooth hypersensitivity. The essay shall compare whether using this topical fluoride is more effective when compared to the application of fluoride Iontophoresis. The PICO format shall be employed in analyzing three research papers related to this topic.

a) Article One.

Title

Pesevska, S., Nakova, M., Ivanovski, K., Angelov, N., Kesic, L., Obradovic, R., & . Nares, S. (2010). Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment. Lasers In Medical Science, 25 (5), 647-650.
 

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ii) Purpose

The authors of this paper carried out this study to investigate and compare the efficiency in using topical fluoride and laser techniques in the treatment of tooth sensitivity. This article illustrates the benefits of using fluoride treatment through topical application and how this technique is more superior and effective compared to low laser radiation (Pesevska et al, 2010). Dental Health PICO Essay.

At the same time, these two techniques are compared for efficacy when it comes to the management and treatment of tooth hypersensitivity.

iii) Methods

This research study employed the use of fifteen patients who acted as an experimental group. This small sample size of n=15 was meant to monitor closely the effects of each individual and the response of the teeth towards sensitive items (Pesevska et al, 2010). The sampled participants were each treated with a diode laser that had a low energy level on each side. This diode was meant to monitor the hypersensitivity level of teeth after the respective individual underwent the process of root canal, root planning and scaling (Pesevska et al, 2010).

The methodology also had a control group where fifteen other patients (n=15) were given the topical fluoride treatment. The latter contained a combination of protective varnish and fluoride that was meant to desensitize the teeth. All these sampled participants or patients were given a baseline encounter after which the pain and hypersensitivity of teeth was measured on a two-day interval. This pain was rated as low, medium or high by each of the patients subjected to this study Dental Health PICO Essay.

iv) Results

The findings of this study indicated that the occurrence of tooth hypersensitivity was significantly reduced by 26.7%. These results were achieved on the second day after the treatment was administered to the patients (Pesevska et al, 2010). This is in contrast to the control group that was given topical fluoride for treatment of teeth hypersensitivity that did not report any decrease or changes after this medication was administered. The complete absence of tooth hypersensitivity was only reported when the patients were given low laser treatment. In fact, the results showed that at least 87% of the patients who received diode laser treatment showed lesser hypersensitivity of teeth as compared to a dismal 26% of patients who were given topical fluoride treatment (Pesevska et al, 2010).

v) Critique

This research study settled for the use of a small sample size that is not representative of the entire human population that suffers from teeth hypersensitivity problems. Therefore, the findings could not be graphically drawn to indicate that the treatment regimen tested is conclusive based on the given sample size (Pesevska et al, 2010). A larger number of participants could have been sampled so as to make the study more representative and improve the validity of the findings. Dental Health PICO Essay.

vi) Conclusion

The authors of this paper concluded that the use of diode laser treatment of low energy is one of the successful ways of managing and treating tooth hypersensitivity (Pesevska et al, 2010). This is in comparison to the use of topical fluoride that yields less success since it does not manage to completely eradicate tooth pain or issues of sensitivity.

 

b) Article Two

i) Title

Chen, L., Meng, Q., Chen, Y., Smales, R., & Yip, K. (2008). Effects of fluoride iontophoresis  on the reduction of teeth sensitivity and microtensile bond strength between dentin and two adhesive systems. Journal Of Dentistry, 36 (9), 697-702.

 

ii) Purpose

Chen et al (2008) carried out this study to evaluate and determine the effect of using fluoride iontophoresis in reducing tooth hypersensitivity. This technique was mainly applied to determine the tensile strength of bonds between the coronal dentin and two additional adhesive systems. Additionally, the tubule occlusion was also measured quantitatively with regards to its role in minimizing the sensitivity of teeth.

iii) Methods

The researchers made use of twelve teeth that were obtained from willing individuals who were made known about the study. These teeth were the third molars that were divided into four different groups (Chen et al, 2008). The first group involved treatment with a total adhesive system only while the second group was treated with the same adhesive after undergoing treatment with fluoride iontophoresis. The third group was treated with a different adhesive known as a “self-etching” system. Finally, the fourth group was treated with the same adhesive after fluoride iontophoresis was administered. These four groups were also fixed with a composite resin that was meant to produce additional beams to enhance their tensile strength. Dental Health PICO Essay.

iv) Results

The results of this experiment were obtained after each test was treated differently through fluoride iontophoresis. The four groups were passed through scanning electron microscopes or SEMs where the images were recorded and analyzed through statistical software. The results were analyzed through the use of analysis of variance or ANOVA, probability and significant difference tests (Chen et al, 2008). According to the results, there was a significant difference (P ≤0. 02) among the groups that were treated with fluoride iontophoresis. The other groups that did not undergo the latter process registered no significant difference (P=0.92) in terms of reducing the sensitivity of teeth.

v) Critique

This experimental research made use of different statistical tools that did not properly capture the effectiveness of using fluoride iontophoresis as a mode of treating hypersensitivity in the teeth. Moreover, the use of molar teeth extracted from patients could not be deemed as a viable way of determining the reduction of pain (Chen et al, 2008). The alternative approach of measuring tubule occlusion is so not very appropriate with regards to the management of this dental condition.

vi) Conclusion

This research study was able to conclude that the use of fluoride iontophoresis is an effective way of treating the occurrence of hypersensitivity in the teeth. The significant increase in the tubule occlusion was used as the indicator of the level of effectiveness of this technique (Chen et al, 2008). Hence, dentists can recommend to their patients that the hypersensitivity in the teeth can be significantly reduced and managed through the implementation of fluoride iontophoresis. Dental Health PICO Essay.

 

c) Article Three

i) Title

Vrbi., B,. Caron;, V., & B. Košmelj, V. (2008). Efficacy and Cost analysis: Comparison of topical fluoride application and fluoride iontophoresis over a 3-year period. Community Dentistry & Oral Epidemiology, 6 (5), 269-272. doi:10.1111/1600-

 

ii) Purpose

This research was conducted through a longitudinal form of study that sought to compare the efficiency in treatment for both topical fluoride use and fluoride iontophoresis over a three-year period (Vrbi et al, 2008). The study aimed at investigating which among these two techniques is more appropriate in terms of both efficacy and cost as well.

iii) Method

The study employed the use of three groups of patients who were subjected to different forms of treatment. The first group was placed under topical application of fluoride; the second group was administered with fluoride iontophoresis procedures while the third group was used as the control (Vrbi et al, 2008). These forms of treatment were subjected to the patients for a period of three years with intervals of four months each.

iv) Results

The results of this study showed that the effectiveness of the topical application of fluoride in treating tooth hypersensitivity was estimated to have a success rate of 30%. In terms of the costs, topical application was also much cheaper and more affordable. On the contrary, the use of fluoride iontophoresis was more efficient at 86% success rate (Vrbi et al, 2008). However, this technique proved to be quite expensive for patients who suffered from severe or acute teeth hypersensitivity. Dental Health PICO Essay.

v) Critique

The duration of this research study was too long such that the patients and sampled individuals would have easily grown tired or weary. Additionally, the financial implications of this study were too high considering the extended time frame employed in the process of comparing the efficacy of these two techniques.

vi) Conclusion

This research was able to illustrate that fluoride iontophoresis is very effective when it comes to the management and reduction of issues of hypersensitivity in the teeth. However, the process can be quite costly due to the technical aspects involved (Vrbi et al, 2008). On the other hand, the use of topical application of fluoride is less effective but affordable altogether. Therefore, fluoride iontophoresis should be the recommended regimen for minimizing teeth hypersensitivity for people facing a recurrent problem in their dental area.

 

References

Chen, L., Meng, Q., Chen, Y., Smales, R., & Yip, K. (2008). Effects of fluoride iontophoresis on             the microtensile bond strength between dentin and two adhesive systems. Journal of   Dentistry, 36 (9), 697-702.

Pesevska, S., Nakova, M., Ivanovski, K., Angelov, N., Kesic, L., Obradovic, R., & … Nares, S.    (2010). Dentinal hypersensitivity following scaling and root planing: comparison of low-      level laser and topical fluoride treatment. Lasers in Medical Science, 25 (5), 647-650.          doi:10.1007/s10103-009-0685-0

Vrbi&bcaron;, V., & B. Košmelj, V. (1978). Cost analysis of 3 years of topical fluoride     application. Community Dentistry & Oral Epidemiology, 6 (5), 269-272.        doi:10.1111/1600-       0528.ep12103578 Dental Health PICO Essay

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How fast food affect people’s health

In all likelihood, we have heard of the phrase eat healthy, live healthy. The message is disseminated using various mainstream media or channels including televisions, radio stations, the Internet, print media, films and others. Without a doubt, the aim is to sensitize the public over a growing problem with regard to diet and diseases. Regrettably, modern societies including the United States have subscribed to systems or habits of food consumption that lead to adverse health effects. Indeed, the past few decades have witnessed increased consumption of fast food products as lifestyle changes continue happening in the society. Undoubtedly, urbanization and globalization have meant that people change their eating habits leading many to consume fancy, high calorie fast foods. Nevertheless, extensive research regarding these foods has been carried out giving a grim picture altogether. The effects on human health are simply devastating, and more needs to be done to curb the menace.

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Fast food is a general term used in describing the types of food prepared in an eatery or café with limited service staff, and from which the majority of foodstuffs are taken away or consumed off premises (Smith, 1-10). The term fast food is closely associated with junk food and it is frequent to find the two used interchangeably- underlining their unhealthy nature. Nonetheless, unhealthy lifestyle including food practices has been shown to have adverse effects on health. A widespread effect on people’s health is contribution to escalating population rates of obesity in America and other developed societies around the world. In fact, the connection between fast food and obesity levels is clear because more people are opting for the easier option by preferring to consume foodstuffs prepared away from home. Worth noting, is that these foods not only are prepared quickly and easily but also accessed quickly. It also means that little consideration –if any- is given to these foods as far as health concerns are concerned. For instance, fast food are known to contain considerably high levels of saturated fat. Aloia et al (4) argues that studies indicate that a positive association exists between frequency of fast food joint use and weight gain. As a result, fast food companies are expanding at unprecedented rates as more people consume these foods. Central obesity, for instance, is becoming all too common in modern, urbanized societies as people consume more fast foods. Altogether, obesity cases have been on the rise thus placing millions of life at risk of developing other health complications. As an example, obesity has been linked to various health conditions including serious illnesses such as coronary artery disease as well as diabetes. In fact, such diseases have been on the rice in recent times and fast foods have steadily been cited as a contributing factor. This indicates that fast food can have devastating impact on human health leading to terminal illnesses among other problems.

Perhaps, the effects of fast food on our health are best captured in M. Spurlock’s film Super Size Me. This work goes beyond the normal to explain the manner in which fast foods are dangerous because of their addictive nature leading to obesity and weight issues. The film is quite clear in delivering its message; that the United States faces an epidemic (obesity and related health challenges) all because of fast food. In essence, fast food harms your health. Indeed, this appears the obvious – but quite worrying considering the disturbing statistics. For instance, the film highlights that up to 60 percent of American have weight issues (Scott web). Such figures are used to draw attention to the fact that fast foods are not only affecting people’s lives but also the quality of life. The film depicts obese persons cruising fast food causeways as an indication that the foods have brought them health issues. In particular, the effect of these foods on people’s health is the fact that they make people eat with less of no planning. People become addicted thus engaging in what may be described as binge meals at fast food restaurants – indicating the rate at which people tend to consume these high calorie products. Often, fast foods are appealing probably because of their attractive coloring as well as dense sugar content. However, one must also know that dense sugar content and high fat content have been linked to dental cavities as well as diabetes among other health problems. In sum, the film highlights the fact that fast food should not form our diets because we are likely to suffer. Most importantly, one is likely to suffer addiction leading to high consumption of these products and hence the many health problems, which may follow in a chain.

Elbel et al (493-500) also evidence the fact that fast foods are highly addictive, as people make these foods their choice. In particular, their study points out that children are likely to prefer these foods probably because of their attractive appearance and or tastes. The result is that obesity continues to plague United States because persons contract this health condition from an early age. More worrying is that obesity and other health related problems continue plaguing the American population despite recent efforts to curb the menace. For instance, there has been heightened public attention or alarm regarding the obesity epidemic as well as laws including calorie menu labeling (Elbel et al 493-500). Nevertheless, such measures are undertaken to help the population make better-informed as well as healthier food choices and perhaps avoid or minimize visits to fast food restaurants. In sum, increases in obesity among children and general population are significantly attributed to unhealthy nutritional habits. Fast food emerges as a well-known contributor to caloric consumption. In addition, it has been directly associated with higher obesity rates among young individuals. Franck et al (2) points out that there has been a steady rise in daily calorie consumption leading many policymakers to believe that targeting food consumption is the best means to address the epidemic.

Smith (1-10) notes it is beyond doubt that portion sizes and waistlines are expanding throughout the country. Restaurant meals have gotten larger as the population emphasizes on getting more food for their money. The result is that people are surrounded by larger portion sizes offered at relatively low prices, and thus appealing to their economic sensibilities. More often than not, however, these foods are unhealthy despite their big sizes. Fast foods from burgers to different types of snacks fall under this category because of their unhealthy characteristics including high calorie. Altogether, the equation is quite simple because people are increasingly becoming addicted to fast foods and thus eating more than they can use. The result is many health problems including obesity and weight gain. As mentioned above, unhealthy weight gain in humans has been linked to a number of health problems including coronary artery disease as well as diabetes. Some of these diseases are terminal and their management may lead to significant costs.

In conclusion, the issue of fast foods is a global concern even though it appears to be affecting developed nations (including the United States) at a greater rate. Perhaps, this is because globalization and or urbanization are significantly higher in such regions and the population has resulted in consuming these types of foods. Nevertheless, consumption of fast food and its impact on people’s health cannot be underestimated. Indeed, this has seen governments and other concerned institutions increase their efforts with regard to sensitizing the public over healthy eating practices for better living. People make choices about what they consume and thus knowledge highlighting the eating habits and nutritional aspects can prove handy. In essence, people equipped with necessary information are likely to make better decisions with regard to what they consume thus avoiding fast food altogether. In particular, a population aware of adverse health effects of these foods is likely to make effort to change towards good eating habits. In total, to avoid the negative health effects, humans ought to change their lifestyles including eating habits. For instance, they need to replace fast food with nutritious food and most probably prepare food at home rather than visiting restaurants offering fast foods. Worryingly, junk food companies have adopted marketing strategies that seem to make them more appealing than nutritious foods. The outcome is that people from different backgrounds are at the risk of developing grave health conditions as they consumer fast foods.

 

Work cited

Aloia, Christopher et al.
Differences in perceptions and fast food eating behaviors between             Indians living in high – and low-income neighborhoods of Chandigarh, India
. Nutrition        Journal 2013, 12:4.

Elbel, B et al.
Child and adolescent fast-food choice and the influence of calorie labeling
.   International Journal of Obesity, (2011), 35, 493–500.

Franck, Caroline et al. Taxing junk food to counter obesity.
American Journal of Public Health,    November 2013, Vol. 103, No. 11.

Scott, A.
Super Size Me (2003)
. New York Times. 7 May 2004. Available from             http://www.nytimes.com/movie/review?res=9C0CE5DC163CF934A35756C0A9629C8B            63 03 Aug 2014.

Smith, Lindsey et al. Trends in US home
food
preparation and consumption: analysis of national nutrition surveys and time use studies from 1965-1966 to 2007-2008.
Nutrition Journal.        2013, Vol. 12 Issue 1, Special section p. 1-10.

PICO Research Assignment – Xerostomia, xylitol & biotiene

PICO Research Assignment

This paper is a brief essay that discusses dental hygiene in terms of whether xylitol as compared to biotiene mouth spray can help to increase salivation in the oral cavity for patients with xerostomia. This essay adopts the PICO tool to analyze this dental issue and provide viable solutions.

PICO Question: For client with Xerostomia, will xylitol as compared to biotiene mouth spray help to increase salivation in the oral cavity?
 

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Article One:

Stack, K. M., & Papas, A. S. (2014). Xerostomia: Etiology and Clinical Management.  Nutrition In Clinical Care, 4(1), 15-21.

This article talks about the different clinical methods that can be used to treat xerostomia as one of the common dental problems. The author explains that xerostomia mainly manifests in the form of dryness of the mouth and if it is not treated early it can lead to more severe oral cavity diseases (Stack et al, 2014). The article highlights the common symptoms of this disease such as difficulty in chewing, swallowing and even burning sensations. At the same time, the paper provides various forms of therapy and treatment for xerostomia (Ship et al, 2014) PICO Research Assignment – Xerostomia, xylitol & biotiene.

The application of the PICO tool to analyze this paper would show that the population being referred to in this case are the patients or victims of xerostomia. The intervention that is recommended is the various ways of treating this dental malfunction and they include use of fluoride therapy, regular dental visits as well as using dental products that contain xylitol, biotene and even olive oil (Stack et al, 2014).  The author insists that both biotene and xylitol are very helpful and efficient when it comes to treating xerostomia (Ship et al, 2014). In terms of the comparison aspect, xylitol happens to be more effective. PICO Research Assignment – Xerostomia, xylitol & biotiene.

This is shown in the outcome of this essay that illustrates how patients who used dental products with xylitol were able to benefit from curing and reducing the occurrence of xerostomia. This is because they are able to stimulate the salivary glands and increase flow of saliva in the mouth (Stack et al, 2014). Hence, the issue of dryness in the mouth and other uncomfortable symptoms are totally eradicated.

Article Two:

 Danhauer, J. L., Johnson, C. E., Baker, J. A., Ryu, J. A., Smith, R. A., Umeda, C. J., & … Pratt, S. (2015). Will Parents Participate in and Comply With Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?. Language, Speech & Hearing Services In Schools, 46(2), 127-140. Doi: 10.1044/2015_LSHSS-14-0048

This paper highlights the importance of using xylitol so as to control acute otitis which is one of the symptoms associated with xerostomia. The article indicates that if a child was placed on xylitol which mainly contains natural sugars and alcohol, they are able to prevent the effects of xerostomia from spreading and keep them minimized (Danhauer et al, 2015). This is because this dental condition is quite severe and its effects can result in chronic infections in the nasopharyngeal regions such as the nose and middle ear. The author of this paper recommends the use of this treatment as opposed to other dental therapies that are mostly obtained over the counter (Bruce, 2009). PICO Research Assignment – Xerostomia, xylitol & biotiene.

In terms of using the PICO tool, the target population are people and children that constantly suffer from xerostomia. The intervention used is xylitol in trying to treat xerostomia as compared to using biotene or other products like olive oil (Danhauer et al, 2015).  The comparison to be drawn in this case would be how the different dental products can be effective in treating this oral problem (Bruce, 2009). The outcome shows that children that were placed on this form of treatment were able to have the symptoms and occurrence of xerostomia relieved among a large population (Bruce, 2009). Conclusively, dental products and mouth sprays that contain xylitol can effectively help in increasing production of saliva within the oral cavity for patients suffering from xerostomia.

 

References

Bruce, S. D. (2009). Radiation-Induced Xerostomia: How Dry Is Your Patient?. Clinical Journal of Oncology Nursing, 8(1), 61-67. doi:10.1188/04.CJON.61-67

Danhauer, J. L., Johnson, C. E., Baker, J. A., Ryu, J. A., Smith, R. A., Umeda, C. J., & … Pratt, S. (2015). Will Parents Participate in and Comply With Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?. Language, Speech & Hearing Services In Schools, 46(2), 127-140. Doi: 10.1044/2015_LSHSS-14-0048 PICO Research Assignment – Xerostomia, xylitol & biotiene

Ship, J. A., Mccutcheon, J. A., Spivakovsky, S., & Kerr, A. R. (2014). Safety And effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth. Journal Of Oral Rehabilitation, 34(10), 724-732. doi:10.1111/j.1365-2842.2006.01718.x

Stack, K. M., & Papas, A. S. (2014). Xerostomia: Etiology and Clinical Management. Nutrition In Clinical Care, 4(1), 15-21. PICO Research Assignment – Xerostomia, xylitol & biotiene.

Lactobacillus Casei

Relevant issue/subject identified and appropriately introduced

In the backdrop of high cases of civilization diseases, industry and science in general direct their effort toward food products. In particular, interest is directed toward research beyond the regular nutritional function to deliver additional health benefits. In essence, science is trying to minimize risk of diseases. This has led to the emergence of what is commonly referred to as functional foods. The term encompasses a broad range of products and relates to foods that possess a potentially positive impact on health past basic nutrition. Probiotics or bifidobacteria are an example. The consumption of lyophilized or living cultures of bifidobacteriais known to have several benefits including enhancing the immune system action and prevent coronary diseases as well as cancer. The beneficial consequences of bifidobacteria on gastroeneteretis, bowel syndrome, hyperlipidemia, inflammatory bowel disease, diarrhea and hepatic disease are well known. Nevertheless, the most frequently used probiotic products include bio-yoghurts retailed by wholesalers and others. Worth noting is that besides the archetypal yoghurt strains including Streptococcus thermophilus and lactobacillus delbrueckii ssp bulgaricus, bio-yoghurts contain cultures of live bifidobacteria such as lactobacillus casei and others. This indicates a rising consumer interest in such products in addition to commercial competition that has meant that producers are competing in diversifying range of goods/products. In most cases, the assortment takes the form of new and exciting flavor achieved through adding rare fruit. Without a doubt, such actions are taken to ensure competiveness in the complex market of today’s world. However, while research on probiotics has increased over the last decades, few works exist describing the manner in which they function leading to the desired health benefits. In essence, majority of researchers are yet to establish the manner in which such probiotics as lactobacillus casei function thus affecting human health. Rather, available scientific studies on probiotics focuses on the products containing them including yoghurts. This has meant that the effects lactobacillus and others on human system has been given a peripheral role in the studies. It follows that while consumers are aware of some of the benefits derived from consuming related products, many do not know the best products to choose from the saturated market. In sum, studies are yet to provide concrete evidence on the manner in which lactobacillus casei and others function thus enhancing the human system in one way or the other.

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Concise and clear discussion of the current status of knowledge in the chosen subject area.

Lactobacillus casei strains represent gram-positive, facultative anaerobic, industrially significant LAB (lactic acid bacteria) that has been principally used as fibidobacterias and specialty cultures for various products development. In fact, it has been suggested that their wide commercial applications may be a reflection of their extraordinary ecological adaptability to different habitats. Nevertheless, Lactobacillus casei may be isolated out of raw as well as fermented dairy products (including yoghurts) and animal products.  Despite all these findings, many dimensions or subjects involving the topic of Lactobacillus casei are at infancy or unknown altogether. As mentioned above, few works exist describing the manner in which probiotics function leading to the desired health benefits. In most cases, such a situation results from the failure to understand the genetic basis regarding the ecological flexibility in lactobacillus casei and others. Currently, the field of probiotics is filled with comparative genomic studies suggesting extensive gene loss as well as gene acquisitions throughout evolution of lactobacilli –presumably through bacteriophage or conjugation mediated hgts (horizontal gene transfers) that may have facilitated the adaptation to different ecological niches (Makarova 2006, p 15611-15616). For instance, milk as well as vegetable-associated sub-species of lactobacillus has been found to contain high level of genetic heterogeneity. As well, correlations have been demonstrated between specific gene acquisition or loss and the capacity of the species to inhabit specific habitats. Worth noting is that these are pure attempts to explain the manner in which probiotics including lactobacillus casei may affect human system (Makarova 2006, p 15611-15616). What is more, comparative genomic examination on lactobacillus strains of different sources show genomic regions with atypical base composition pinpointing evolutionarily recent acquisitions (Makarova 2006, p 15611-15616). In sum, it becomes evident that current knowledge does not add up and the manner in which lactobacillus casei and others affect human system is far from clear.

Worth noting is that molecular typing of Lactobacillus casei is vital to comprehending the evolutionary adaptation of the species to various ecological niches including the manner in which it helps our body system. What is more, definitive identification of Lactobacillus casei at the strain level is crucial for a range of industrial applications because it facilitates tracking of various strains with such industrially relevant characteristics as probiotic and antimicrobial elements. Currently, a number of molecular typing methods including randomly amplified polymorphic DNA, temporal temperature-gradient electrophoresis as well as pulsed-filed gel electrophoresis have been used in Lactobacillus casei (Farnworth 2008, p 49-54). The latter approach has been reported to show the highest discriminatory influence. Nevertheless, these the approaches have less effectiveness in describing underlying phylogenetic associations and thus making it difficult to establish how Lactobacillus casei and others work leading to health benefits. In essence, current approaches have proved to be of little use as far as the area of human health is concerned. In total, current knowledge in the area of probiotics is non-conclusive with regard to the manner in which it positively influences body system.

Evidence of wide range of reading

Most strains related to lactobacillus casei including shirota are rod-spaped and occur either singly or in pairs. In addition, they have been found to occur in short chains constituting 3 or 4 cells. Normally, lactobacillus casei strains are capable of growing at temperatures ranging from 27 through 43 degrees (Gaynor 2012, p 10). The strains can grow at low ph level of 3.5, but optimal ph is 6.5. Lactobacillus casei is a facultative homo-fermentative lactic acid bacteria, and produces 2 lactic acid molecules out of every glucose molecule – though it also generates small quantities of ethanol, acetate and diacetyl. Nevetheles, regarding the fermentative characteristic of lactobacillus casei strains, lactic acid is generated from adonitol, ribose, d-glucose, galactose, mannitol, D-mannose, salicin, turanose and sorbitol (Gaynor 2012, p 10). In addition, it is weakly generated from sucrose and inositol, but from inulin, glycerol, glycogen, starch and xylitol.

Lactobacillus casei relates to a harmless and non-pathogenic microorganism that is broadly recognized for its properties and attributes that have been shown to be beneficial to the human body. As a type of bacteria, lactobacillus casei helps to boost human body defense system through restricting the development of certain types of dangerous bacteria that lead to infection. This means that lactobacillus casei is beneficial and occurs naturally in human’s mouth as well as intestines. Essentially, the bacteria is known to produce amounts of lactic acid which is helpful in lowering the levels of ph in human’s digestive system thus impending the development of harmful bacteria. In addition, lactobacillus casei may be present if fermented dairy as well as fermented and fresh plant products. Such sources may include yoghurt and other food sources including fermented green olives. Different findings indicate that scientists have found the bacteria to have beneficial characteristics that improve human health. In particular, the bacteria is not only able to improve but also promote digestion. In addition, some strains associated with lactobacillus casei help manage diarrhea and others have an anti-inflammatory influence on the gut (Probiotic.org 2009, web). There are several other benefits linked to the bacteria as far as human health is concerned including alleviating constipation, lactose intolerance and general modulation of human immune system. In sum, lactobacillus casei is classified under friendly bacteria that are significant to proper functioning of the immune system, digestion and absorption of nutrients as well as protection against microorganisms that lead to disease. As such, ensuring that the body receives an appropriate level of lactobacillus casei is important. Nonetheless, probiotic strains including lactobacillus casei are selected to give beneficial impacts on the host as well as on the metabolism or composition of the intestinal microbiota without necessarily inflicting adverse transformations including production of toxins and epithelial cell invasion –effects that would imperil the nutritional or health status of the host. Resultantly, lactobacilli have been ingested on a daily basis since fermentation of milk was discovered. This includes the probiotic utilization of various lactobacillus species for decades, and possibly was ingested from the earliest history since they normally inhabit green plant material (Gaynor 2012, p 20). Research indicates that lactobacilli are ever-present because they are found in virtually all carbohydrate rich substances. Several authors also report that in healthy persons, lactobacilli are normal and found in the ileum, the oral cavity as well as the colon. In addition, they are dominant microorganism in human’s vagina. In sum, their close relation with human health is evident and their long application as probiotics without risk to humans has been noted. In fact, their significance is underlined by the fact that no pathogenic characteristic has been associated with them.

A discussion by Cabana et al (2006, p 407) observed that while probiotic’s optimal dose remains an area under investigation, there exists no reports of toxicity linked to exceeding a specific dose. This indicates that their pathogenic characteristic is quite low or non-existent altogether. On the other hand, Vandenplas et al (2007, p 46) noted that such probiotics as lactobacillus casei never colonize human’s grastro-intestinal tract because they become undetectable shortly after stopping the administration. The outcome is the absence of risks for long-term side effects. Bearnadeu et al (2008, p 157) noted that the risk –if any- of bacteremia from bifidobacteria and probiotic lactobacilli is 1 in a million. It can be concluded that the overall risk from lactobacillus and others presents a negligible imperil to consumers of such products as yoghurt. This also includes negligible risk to immune- compromised hosts. In addition, the bibliographical data has been shown to promote the hypothesis that the consumption of lactobacillus strains is not in any hazardous because lactobacillemia induced through food (including fermented dairy products) is extremely rare (Bearnadeu et al 2008, p 157).

According to Guerin-Danan et al (2000, 111-117 am jpdf), yoghurt is explained as a fermented milk obtained through specific fermentation of lactic acid –via the action of streptococcus thermophilus as well as lactobacillus bulgaricus. Ingestion of related products induces transformations in the equilibrium as well as metabolism of the microflora and may therefore a healthful effect on the host. Nevertheless, Guerin-Danan et al (2000, 111-117) notes that fermented milks including yoghurt have substantial health benefits and can be included in human’s diet from an early age. In fact, they act as good sources of vitamins and minerals and have small amounts of lipids. What is more, fermented milks including yoghurt help control the intake of dietary nitrogen elements in human body as well as supply many lactic acids. Nonetheless, the consumed lactic acid bacteria in some measure resist gastric acidity as well as bile salts. This means that it passes live via the gastrointestinal tract in which they may regulate the metabolism and balance of endogenous microflora. The regulation of such modifications is crucial to health because microflora (mouth and intestinal) can exert either advantageous or disadvantageous effects on the host. Guerin-Danan et al (2000, 111-117) also note that other lactic acid bacteria –particularly those related to lactobacillus – can be included in yoghurt to create fermented milks with definite desirable characteristics including new flavor. Additionally, various lactic acid bacteria are incorporated for the properties – signifying that probiotics can lead to benefits beyond basic nutrition.

According to Wu et al (2011, 1031-1039), lactobacillus casei strains have conventionally been recognized as probiotics. In addition, they have been frequently utilized as adjunct culture in fermented milks in which lactic acid stress is a commonly encountered environmental condition. Lactic acid bacteria relates to a heterogeneous group of bacteria that are applied to create fermented foods (including yoghurt), and are generally accepted as safe. In addition, lactic acid bacteria comprise a collection of microbes related via common metabolic functionality (i.e the creation of lactic acid as a major metabolic end product related to carbohydrate metabolism) and common physiological characteristics. These microbes are Gram positive, catalase-negative, non-spore forming as well as devoid of cytochromes all of which underline their potential in promoting health (Gaynor 2012, p 20). As well, they are preferential non-aerobes, but are acid- tolerant, aero tolerant and strictly fermetative. Even though they are not a closely efined group, lactic acid bacteria usually are considered to constitute a phylogenetically related general such as streptococcus and others. As a result of resemblance in its physiology, ecology and biochemistry, the genus (bifidobacterium) is frequently considered as a lactic acid bacteria – though it may be phylogenetically unrelated. With the exception of some species and strains including streptococcus and enterococcus, most lactic acid bacteria strains are deemed to have no pathogenic potential. Indeed, they are normally found in human’s oral cavity as well as digestive tract. In addition, the bacteria has conventionally known as a probiotic thus used in such commercial products as yoghurts for its health promoting as well as nutritional characteristics. Yet, similar to other lactic acid bacteria, lactobacillus casei encounters a number of stress conditions through industrial processes as well as in the gastrointestinal tract- among which acid stress is an important challenge to its survival. This means that lactobacillus strains including casei are faced with many challenges from the environment and may not survive after all. In some cases, combination of environmental factors may make them harmful altogether.

Attempts to evaluate/appraise cited literature

Besselink et al (2008, p 651-659) cite a publication which claimed to have found higher mortality among persons with acute pancreatitis when treated with strains from bifidobacterium species. In fact, some people questioned the safety of such probiotics as lactobacillus casei. However, a review of the study was conducted and established that- for various reasons- the findings should not make anyone call into question the usefulness of lactobacillus casei and other species. First, it was revealed that the subject in the study were critically ill with a condition that had a mortality rate of up to 30 percent (Besselink et al 2008, p 651-659). In addition, the path of probiotic administration was nasojejunal, rather than oral. In sum, sources that have attemped to disapprove the usefulness and safety of lactobacillus strains have been found to have fundamental flaws as indicated above. In fact, several reserachers have subsequently analyzed such studies and suggested that the high mortality may have been caused by the introduction of enteral solution into the intestine with a huge number of lactic acid-generating bacteria. Worth noting is that fermentation of the enteral nutrition solution via the bacteria may have resulted in the development of semi-solid mass, and lead to bowel ischemia. Besselink et al (2008, p 651-659) notes that the fermented nutrition solution could have remained in the small intestines at the optimal condition with the bacteria without being absorbed. All of this points to a widespread misunderstanding as to the manner in which lactobacillus strains function, thus improving human health.

Other researchers have supported the fact that lactobacillus strains have little or no risk to human health. In fact, Nissen et al (2009, p 290) notes that mucins secreted for intestinal cell membrane are highly complex glycoproteins offering structures as well as viscosity to the mucus layer covering the intestinal epithelial surface. Primarily, this layer is meant to safeguard the underlying cells from such dangers as corrosive gastric acids, invasion by harmful microflora as well as shear forces created by the digestive system. Nevertheless, Nissen et al (2009) claims that probiotic lactic acid bacteria has been evaluated and found to have no ability to corrupt gastric mucin. Indeed, cases of lactic acid bacterial infection are quite rare. The safety associated with strains such as lactobacillus casei and others has been labeled as remarkable given that up to 20 billion administrations are done yearly (Reid and Hammond 2005, p 1491). In sum, as literature indicates, it is evident that lactobacillus strains including casei not only have benefits to human health but also are considered generally safe. The majority of cases questioning safety and usefulness of lactobacillus strains occur in subjects with severely compromised immune status or those with underlying conditions including diabetes, heart disease and other terminal illnesses. In particular, lactobacillus casei found in various food products including yoghurt has been shown to have additional health benefits. Lastly, while some strains of lactobacillus may lead to questions as far as safety is concerned, lactobacillus casei has been found to be quite useful in virtually all environments.

Gap in knowledge identified which could form a project/dissertation

As evidenced in the above literature review, there exists considerable gap in knowledge as far as safety of lactobacillus strains is concerned. In essence, existing studies are yet to link the dots and provide a conclusive report indicating the manner in which such lactobacillus strains as casei lead to improved human health. This also means that different studies often give conflicting findings as evidenced above. For instance, Besselink et al (2008, p 651-659) note cases in which studies want us to believe that some products of lactobacilli- including lactobacillus case- could lead to adverse effects. However, a closer look into the study reviews provided in this paper reveal that lactobacillus strains are rather safe. In fact, the gap in the knowledge is evidenced by studies claiming that lactobacillus species have no detrimental effect whatsoever. This means that humans should consume them is large quantities without the fear that they could affect them in one way or the other. Possibly, this gap, results from the fact that few studies have ventured into investigating the manner in which lactobacillus casei functions, and thus helping humans. In essence, studies are yet to reveal the chemical reactions and or combinations of these strains in humans leading to desired health benefits. nonetheless, this calls for further investigation or projects to test various bifidobacteria-containing products and show how they help improve one’s health.

Specific purpose of your proposed investigation

The purpose of the proposed investigation is to bridge the gap in knowledge specifically by illustrating whether and how lactobacillus casei –and other lactobacillus species- work to improve overall health. In turn, the investigation will provide useful information on whether we should trust lactobacilli-containing products’ safety.

Specific data/information to be investigated identified

Some of the data and or information making up the proposed investigation include strains and growth conditions in which lactobacillus casei, including yoghurt, growth is to be investigated. Investigation the growth of this train is crucial in understanding the manner in which lactobacillus casei influence human health positively. In addition, acid challenge and acid tolerance analysis is to be covered in this investigation to find out the manner in which acids –including those constituting lactic acid bacteria- affect species development and or functioning given different conditions. For instance, using the information, this investigation will seek to establish whether human intestinal conditions could lead to any undesirable effects on the species. As well, information on measurement of epithelial/membrane lateral diffusion will constitute part of the investigation. This will also include investigation of conditions likely to affect the membrane in one way or the other. In addition, fatty acid extraction as well as analysis will form part of the investigation. The information in this part will include a certain technique to identify the manner in which saturation and extraction of fatty acid occurs. Last but not the least, information on examination of inner membrane permeability will be included to assess the permeability through cells. Ultimately, the information will be helpful in revealing lactobacillus species’ functionality in humans and how it leads to improved health.

How will investigation take place? Details of sampling/collection/analysis of data.

The investigation will involve a test involving the effect of lactic acid stress (LAS) on the lactobacillus casei cell membrane as well as its acid resistant mutant (Lbz-2). The test will largely involve data sampling (Cai et al, 2007, p 2655). The two strains lactobacillus casei and acid-resistant mutant will be grown under certain conditions in chemostats.  Steady-state chemostat cells –at pH 6.5- will be harvested.

Ethical issues surrounding the proposal

Ethical considerations are usually part of any project, and particularly those involving laboratory tests. In the proposal, cell integrity is crucial in maintaining cell viability as well as metabolic function. For instance, the data analysis and tests will have to ensure that subjects are handled with utmost care to ensure that wastage and stress is minimized. In addition, ethical considerations surrounding the proposal will include honesty and fairness. The two aspects are crucial in ensuring that integrity of the entire project is compromised. In conclusion, lactobacillus casei and other species are known to have myriad benefits to human health. The project will reveal the way lactobacillus species, in particular casei, affect human systems including cell membrane functionality.

 

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Probiotic.org, 2009, Lactobacillus casei, [online], Retrieved:            http://www.probiotic.org/lactobacillus-casei.htm 26 Jul 2014.

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ed, USA, CRC Press.

Ashley, M, 2013, Top 10 UK yoghurt brands, [online],         http://www.dairyreporter.com/Manufacturers/Top-10-UK-Yogurt-Brands-Mueller-  dominates-Danone-dwindles 26 Jul 2014.

Cho, S, 2010,
Handbook of prebiotics and probiotics ingredients: health benefits and food applications,
CRC Press, USA.

Wu, C et al, 2012, lactobacillus casei combats acid stress by maintaining cell membrane     functionality, J Ind Microbiol Biotechnol, (2012) 39:1031–1039 DOI 10.1007/s10295- 012-1104-2

Duda-chodak, A et al, 2008, The effect of antioxidants on lactobacillus casei,
Acta Sci. Pol.,         Technol. Aliment. 7(4) 2008, 39-51

Cats, A et al, 2003, Effect of frequent consumption of a lactobacillus casei-containing milk drink             in helicobacter pylori-colonized subjects, Aliment Pharmacol Ther 2003; 17: 429–435.

Gaynor, P, 2012, Generally recognized as safe (GRAS) determination for the use of lactobacillus             casei strain shirota as a food ingredient, Yakult Honsha Co. ltd, Japan.

Cai, H et al, 2007,
Genotypic and phenotypic characterization of lactobacillus casei strains            isolated from different ecological niches suggests frequent recombination and niche          specificity
, Microbiology (2007), 153, 2655–2665.

Makarova, K., et al, 2006,
Comparative genomics of lactic acid bacteria
, Proc Natl Acad Sci U S             A, 103, 15611–15616.

Guerin-Danan, C et al, 2014, Milk fermented with yogurt cultures and
Lactobacillus casei           
compared with yogurt and gelled milk,
Am J Clin Nutr
1998;67:111–7.

Schiffer, C et al, 2011, A strain of lactobacillus casei inhibits the effector phase of immune           inflammation,
J Immunol
2011; 187:2646-2655; Prepublished online 1 August 2011;             http://www.jimmunol.org/content/187/5/2646 doi: 10.4049/jimmunol.1002415

Otles, S, 2013,
Probiotics and prebiotics in food, nutrition and health
, USA, CRC Press.

Fanun, M, 2011,
Colloids in biotechnology
, USA, Taylor and Francis, LLC.

Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

I overview

Fig. 1_Clinical situation of a patient

with gingival recession. The

occurrence of gingival recession is a

precursor to the loss of cement,

owing to poor oral hygiene, the

exposure of tooth necks and dentine

hypersensitivity.

laser treatment of dental hypersensitivity

_Introduction

More than two decades ago, laser applications in

the treatment of dentine hypersensitivity were introduced to dentistry. Many clinical studies using

different laser types have been published since. This

overview summarises the basic and clinical aspects,

including treatment protocols.

_The hypersensitive dental neck

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER NOW

Dentine hypersensitivity is a widespread painful

condition in dentistry (Orchardson et al. 2006;

Schwarz et al. 2002). Unfortunately, this clinical

condition is often poorly understood (Pesevska et

al. 2010). It is important to understand this condition in light of dental therapy because the need for

treatment is increasing (Gerschman et al. 1994;

Miglani et al. 2010). Hypersensitivity occurs when

tooth necks are exposed. Brannström’s hydrodynamic theory describes these mechanisms. Chemical, osmotic, physical or mechanical stimuli induce

movement of fluid in dental tubules, which activates pain fibres—mainly A- fibres—at the pulpdentine border (Brannström 1992). Afflicted patients describe an intense and sharp pain of short

duration that cannot be ascribed to any other form Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

of dental defect or disease (Canadian Advisory

Board on Dentin Hypersensitivity 2003). In a huge

number of cases, these symptoms are triggered by

cold and are not related to restorative or caries

therapy. The well-being of patients who suffer from

dentine hypersensitivity is often affected. Daily

stimulation, for example eating or teeth brushing,

could induce considerable pain (Rösing et al. 2009;

Tengrungsun et al. 2008).

Today, more than 30 % of the adult population

of industrialised nations is thought to be affected

(Ritter et al. 2006; Gillam et al. 1997), but the actual

prevalence is still unknown (Rösing et al. 2009). The

reported incidence mainly depends on the population under examination and the methodology of

the studies, which vary a lot. Middle-aged patients

are most often affected (Al Sabbagh et al. 2004), but

a growing number of young persons are affected by

dentine hypersensitivity (Sykes 2007). The higher

frequency of hypersensitivity, even in middle-aged

adults, could be explained by increasing exposure of

tooth necks, which occurs increasingly early on in

young people (Dowell et al. 1983). The main reasons

for exposure are erosion, abrasion and attrition.

However, erosion is most likely to be the main factor (Addy et al. 1994; Gillam et al. 1997). This comes

from an increasing awareness of dental hygiene,

which has resulted in well-intentioned but incorrect brushing (Fig. 1). For these reasons, sensitive

tooth necks frequently occur opposite the hand

that is brushing. The loss of the thin cementum

layer in the tooth-neck area is responsible for more

than 90 % of the hypersensitive surfaces (Orchardson et al. 1987). As a result, dentine hypersensitivity can be characterised as a tooth-wear phenomenon (Bamise et al. 2008). Restorations, functional

overload and bleaching of vital teeth are also

causes of dentine hypersensitivity (Brannström

1992; Jacobsen et al. 2001; Haywood 2002). Nowadays, one therefore speaks of a multifactorial genesis of dentine hypersensitivity associated with

tooth wear.

Despite intensive research, the precise physiological mechanisms of pain production and transmission in the dental pulp have not been sufficiently determined (He et al. 2011; Bal et al. 1999;

Zhang et al. 1998). The surface texture of dentine,

that is the number of open tubules at the root neck,

is of great relevance to the process of dentine hypersensitivity (Absi et al. 1987; Markowitz 1993;

Fig. 2). The extent of hypersensitivity depends on

Laser treatment of

dentine hypersensitivity

An overview Part I

Authors_Dr Ute Botzenhart, Dr Andreas Braun & Prof Matthias Frentzen, Germany

20 I laser

1_2012

Fig. 1 Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

overview I

the number of exposed tubules (Ngassapa 1996).

Clinical studies (Narhi et al. 1992) and SEM examinations (Absi et al. 1987) have demonstrated that

the dentine of hypersensitive teeth has a considerably higher number of exposed dental tubules

(eight times the number) with a considerably

greater aperture (twice the size) compared with

teeth with no hypersensitivity symptoms (Absi et al.

1987). Since dentine hypersensitivity can occur

even after the closure of most of the dental tubules,

other factors, like inflammatory mediators, are assumed to be involved in nerve stimulation and pain

(Narhi et al. 1992; Ngassapa 1996) in addition to the

hydrodynamic theory.

_Conventional therapy

Currently, a multitude of desensitising agents

are available on the market. Normally, the therapeutic mechanism is based upon the hydrodynamic

theory. By occluding dentinal tubules, movement of

fluid should be reduced. Furthermore, the reduction of pulpal pain-nerve fibre firing should contribute to reduced sensitivity.

The spectrum of applications ranges from

agents for topical application, dentine adhesives,

light-curing primer systems, mucogingival surgery

for soft-tissue management, conventional fillings,

to endodontics as ultima ratio. Topical applications

are the most important for desensitisation; among

them are fluorides, potassium and calcium compounds, hydroxyapatite, bioactive glass and glassceramics, oxalates, glutaraldehyde, formalin and

chlorhexidine. These ingredients are mostly found

in toothpastes, mouth rinses, gels, suspensions,

varnishes or pastes for topical application. They can

also be applied via chewing gum or iontophoresis.

Today, the application of nano-sized particles of

different mixtures is also very popular.

In 1935, Grossman formulated a set of criteria

that desensitising agents are to fulfil. These criteria

are still valid today (Renton-Harper et al. 1992):

– no irritation of pulp tissue;

– painless application;

– easy to apply;

– rapid in effect;

– sufficient efficiency;

– no side-effects; and

– long-term effectiveness.

The predominant number of compounds lead to

a rapid resolution of symptoms, but often they are

only short-lived. In most cases, a long-term occlusion of dentinal tubules cannot be attained. Thus

far, no desensitising substance or method of application has fulfilled all the criteria Grossmann postulated in 1935. There has been a constant improvement in terms of the available means of treatment and active substances, but the reports still

demonstrate difficulty in relieving the pain (Romano et al. 2011). Until recently, no universally applicable substance was available (Mitchell et al.

2011; Tirapelli et al. 2010; Dabahne et al. 1999).

_Laser application

Precipitates and surface coverings disintegrate

after some time, for example owing to the influence

of acid or toothbrush abrasion (Addy et al. 1983).

Conventional desensitising treatments had to be

applied repeatedly at regular intervals to ensure a

durable analgesia (Gillam et al. 1992; Cuenin et al.

1991). The application of laser beams of different

wavelengths and energy levels, alone or in combination with topical application, for example fluoride, is an alternative method for the treatment of

dentine hypersensitivity. Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

_Studies on the effects of

laser application

In vitro and in vivo studies document high effectiveness rates and comparatively long-lasting pain

relief. The most commonly used types of lasers for

the treatment of dentine hypersensitivity already

determined in vivo can be divided into two groups.

Those lasers with a lower output power, low-level

lasers (He-Ne and GaAlAs diode lasers), are applied

to biostimulation and are distinguishable from

laser types with a middle-output power, middleoutput power lasers, which have the ability to morphologically alter dental hard tissue.

The middle-output power lasers include the

Nd:YAG, Er:YAG laser and CO2 lasers (Dederich et al.

1984; Melcer et al. 1985; Featherstone et al. 1987).

The effect of these laser types can probably be attributed to the sealing of the dentinal tubules, nerve

analgesia and placebo effects. The sealing has been

observed to be of long-lasting effect, whereas in

Fig. 2_SEM examination of a human

cervical dentinal surface with open

tubules, after experimental removal

of the smear layer with 50 % citric

acid for one minute

(1,000x magnification).

I 21 laser

1_2012

Fig. 2

I overview

the case of nerve analgesia and placebo effects, the

effects are not durable (Kimura et al. 2000a). Despite the precise mechanisms of laser action, the

long-term value of laser therapy in treating dentine

hypersensitivity is uncertain; current evidence is

based upon a slight superiority compared with conventional topical applications (He et al. 2011).

Laser therapy with low-output power has been

applied to humans since the 1970s and was originally used for wound healing (Kimura et al. 1991,

1993, 1997). In the 1980s, the inhibition of inflammation (Karu 1988, 1989) and the stimulation of

nerve cells were demonstrated (Kimura et al. 1993;

Jarvis et al. 1990).

_Low-level lasers:

GaAlAs laser

Thus far, GaAlAs diode lasers of three wavelengths have been used clinically to treat dentine

hypersensitivity: 780, 830 and 900 nm. The 780 nm

wavelength has been used with good clinical success (30 mW in continuous wave mode [cw] and an

application time of about 0.5 to three minutes;

Matsumoto et al. 1985a). The 830 nm wavelength

for the treatment of dentine hypersensitivity was

first described by Matsumoto in 1990. With an energy setting of 20 to 60 mW in cw mode and an application time of 0.5 to three minutes, the effectiveness of therapy was 30 to 100 %, depending on

the energy level (Matsumoto et al. 1990). The effectiveness of therapy using the 900 nm wavelength

and an output power of 2.4 mW at 1.2 Hz for 2.5

minutes was approximately 73 to 100 % (Kimura et

al. 2000b). Yamaguchi et al. (1990) compared the

application of a GaAlAs diode laser of a wavelength

of 790 nm and an output power of 30 mW and a

placebo in vivo. Significant differences between

laser application and the placebo group were

found. At two hours, one day and five days after

laser application, a significant improvement was

detected (Yamaguchi et al. 1990). Overall, compared with the placebo, an improvement of 60 to

22 % was achieved. GaAlAs laser application with a

maximal energy output of 60 mW did not damage

enamel or dentine surfaces morphologically

(Watanabe et al. 1991).

According to another in vitro study, the application of GaAlAs laser diodes with energy levels of

30 mW (cw, 780 nm), 60 mW (cw, 830 nm) and

10 W (pulsed, 900 nm) did not lead to a significant

increase in the temperature in the dental pulp

(Arrastia et al. 1994). Gerschman et al. (1994) accomplished a clinical double-blind study with

GaAlAs lasers compared with a placebo. During the

therapy, the apical and cervical regions of the tooth

were irradiated for one minute; this procedure was

repeated in one-week, two-week and eight-week

intervals. Dentine hypersensitivity evoked by tactile

and thermal stimuli was measured at each control

and compared with the placebo group. A significant

difference concerning dentine hypersensitivity

was detected during the analysis. It was therefore

deduced that the GaAlAs laser is an effective

method for dentine desensitisation (Gerschman et

al. 1994).

_Combined application of GaAlAs laser

and fluoride Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

In another clinical study, a laser with an energy

density of 3 and 5 J/cm2was applied up to six times

in an interval of 72 hours after each application

(Marsilio et al. 2003). Dentine hypersensitivity was

measured initially after each application, and at 15

and 60 days after application. In more than 85 % of

the teeth treated, an improvement was detected.

Side-effects were not observed (Marsilio et al.

2003). In a comparative study of GaAlAs laser application (630–670 nm) at energy levels of 15 mW

in contact mode for 20 seconds and fluoride application (Fluor Protector, Ivoclar Vivadent), significant and complete relief from pain after three sessions was achieved in 86.6 % of the cases compared

with 26.6 % after fluoridation only (Pesevska et al.

2010). The clinical findings of Noya et al. (2004)

proved that just a single application of GaAlAs laser

(670 nm, 15 mW, 5 J/cm2) yields a statistically significant reduction in sensitivity to mechanical and

thermal stimuli and that two applications are

enough to reduce sensitivity to air. No other application led to any additional benefit (Noya et al.

2004).

A significant reduction in VAS scores was also

detected with laser application for 160 seconds at

an energy density of 4 J/cm2 per dental element at

24 hours and seven days after application compared with a placebo application (Orhan et al. 2010).

All teeth remained vital and no adverse effects were

found radiographically, but the results were not

significantly different from any conventional desensitiser (Gluma Desensitizer, Heraeus Kulzer;

Orhan et al. 2010).

A combined application of GaAlAs laser light

with sodium fluoride (NaF) at an energy output of

15 mW and density of 4 J/cm2 led to no statistically

significant differences between laser application

and combined laser and fluoridation treatment

(Corona et al. 2003).

Whether a combined application of GaAlAs laser

and fluoride is effective in treating dentine hyper22 I laser

1_2012

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Greater New York Dental MeeƟ ng®

570 Seventh Avenue – Suite 800

New York, NY 10018 USA

Tel: (212) 398-6922 / Fax: (212) 398-6934 ::: *1<‘0 &20 E-mail: victoria@gnydm.com ScienƟĮ c MeeƟ ng: Friday – Wednesday, November 23 – 28 Exhibit Dates: Sunday – Wednesday, November 25 – 28 MARK YOUR CALENDAR Aãã›Ä Aã NÊ CÊÝã Never a pre-registraƟ on fee at the Greater New York Dental MeeƟ ng MÊٛ ãHƒÄ 600 EXH®B®ãÊÙÝ Jacob K. Javits ConvenƟ on Center 11th Ave. between 34-39th Streets (ManhaƩ an) ,›ƒQçƒÙã›ÙÝ ,Ê㛽 New York MarrioƩ Marquis ,otel L®V› D›Äã®ÝãÙù Aٛă – NÊ Tç®ã®ÊÄ Lƒã›Ýã D›Äヽ T›‘HÄʽʦù Ι S‘®›Ä㮥®‘ AVƒÄ‘›Ý MÊٛ THƒÄ 350 S‘®›Ä㮥®‘ PÙʦكÃÝ Seminars, ,ands-on Workshops, Essays & ScienƟĮ c Poster Sessions as well as Specialty and Auxiliary Programs E瑃ã®Êă½ PÙʦكÃÝ ®Ä VƒÙ®ÊçÝ ½ƒÄ¦çƒ¦›Ý Sʑ®ƒ½ PÙʦكÃÝ ¥ÊÙ ãH› EÄã®Ù› FƒÃ®½ù EĹÊù N›ó YÊÙ» C®ãù ƒã ®ãÝ B›Ýã çٮĦ ãH› ÃÊÝã ¥›Ýã®V› ã®Ã› Ê¥ ãH› ù›ƒÙ! Sponsored by the New York County Dental Society and the Second District Dental Society GNYDM_2012_A4_engn.pdf 1 NYDM_2012_A4_engn.pdf 1 20.03.12 17:34 0.03.12 17:34 I overview 24 I laser 1_2012 sensitivity is questionable. Results are contradictory, often masked by placebo effects and highly dependent on laser parameters and the given circumstances for each patient. Both methods of treatment, GaAlAs laser application and fluoridation, are suitable for dentine hypersensitivity therapy. _Biostimulative mechanisms of GaAlAs lasers The GaAlAs laser mechanism is thought to be biostimulative rather than effecting morphological changes in dentine. It is assumed that the laser energy is transmitted to the dentine–pulp complex, interacts with the pulp tissue and causes a photobiomodulating effect, increasing the cellular metabolic activity of the odontoblasts and obliterating the dentinal tubules by means of tertiary dentine production (Ladalardo et al. 2004; Walsh 1997). Tengrungsun et al. (2008) compared the efficiency of a GaAlAs laser (790 nm, 30 mW, 1 min) with a dentine bonding agent (Scotchbond, 3M ESPE) and found a statistically significant reduction immediately and 15 days after treatment in both of the two groups. No additional reduction in the level of hypersensitivity 30 days after treatment was observed. The dentine bonding agent was significantly superior to the GaAlAs laser within all measuring periods, thus confirming the assumption that laser light may act in a different way from occluding dentinal tubules (Tengrungsun et al. 2008). The immediate laser effect is assumed to be triggered by placebo effects as a result of endorphin release induced by the activation of the pain inhibition system of the organism. This leads to the release of endorphins by the central nervous system, possibly controlling the painful stimulus at the periphery, and causing biostimulative effects that happen gradually within a few days (Tuner et al. 2002; Kimura et al. 2000b; Trowgridge et al. 1990). Another assumption is the blocking of the depolarisation of C-fibre afferences (Wakabayashi et al. 1993). The exact mechanism of action of low-intensity lasers in dentine hypersensitivity is not thoroughly understood (Orhan et al. 2010). _Infra-red wavelengths and highpower density Laser diodes, some of which have already been tested in vitro and in vivo, with wavelengths in the infra-red area and a high-power density are easily available on the market. Because of the laser–tissue interaction of this laser type with high energy per surface density, its results are comparable to that of an Nd:YAG laser. The sealing ability of this laser type was observed with the parameters 810 nm, 2 W and 30 ms, and was found to be less than that of CO2, Er,Cr:YSGG lasers and Nd:YAG lasers (Gholami et al. 2011). Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity Clinical findings with the use of a GaAlAs laser of a wavelength of 810 nm at 1.5 to 2.5 mW for one minute resulted in a rapid reduction of discomfort, 15 minutes and 30 minutes after laser irradiation (37 % after 15 minutes and 41 % after 30 minutes) compared with placebo laser application with a reduction of 9 %. The improvement remained stable until two weeks (72 %) and two months (66 %) after application compared with placebo laser application (a 28 % reduction at two weeks and 26 % at two months) and the application of 10 % potassium nitrate gel (a 36 % reduction at two weeks and 30 % at two months; Sicilia et al. 2009). _Different effects in different age groups Ladalardo et al. (2004) evaluated the clinical desensitising effect of red and infra-red GaAlAs laser light application (660 nm and 830 nm, 4 J/cm2 , cw, 114 seconds, contact mode) in adult patients of different age groups (25–35 years and 36–45 years) as an immediate (15 minutes and 30 minutes after application; four sessions with intervals of seven days between each session) and late therapeutic effect (15, 30 and 60 days after the conclusion of treatment). Significant desensitising levels were only found in patients aged between 25 to 35 with the 660 nm red laser, which was found to be more effective than the 830 nm infra-red laser immediately after and in the follow-up periods at 15, 30 and 60 days after the conclusion of treatment. In the group of 36- to 45-year-old patients, the effect of the red laser was only moderate, with recurrence of sensitivity, and the infra-red laser was ineffective. The authors concluded that the desensitising effects immediately after laser irradiation resulted from a suppression of evoked potential of the pulp nociceptive nerve fibres, with a better tissue response in the younger group. Pathological processes, regressive or atrophic alterations of the odontoblasts and the dentine pulp complex may lower the reaction potential in older patients, with reduced effectiveness of the laser biostimulation (Ladalardo et al. 2004). A significant clinical improvement was also observed after the combined application of GaAlAs laser (808 nm, cw, contact mode, 25 seconds) and desensitiser toothpaste compared with the toothpaste alone (Dilsiz et al. 2010a). _GaAlAs laser and acid resistance Recently, the GaAlAs diode laser was tested to establish enhancement of the acid resistance of dentine surfaces as a preventive method for hypersensitivity. A degree of improvement in the acid resistance of dentine specimens after laser irradiation (808 mn, cw, 60 J/cm2 ) and erosive challenge (1 M hypochlorous acid for five minutes) was found without creating thermal or structural damage (De-Melo et al. 2010). However, the exact mechanism of action remains unclear. Laser treatment can be a useful tool for rapid reduction in pain, and possibly in the improvement of acid resistance of dentine. Nevertheless, more basic research and longterm clinical trials are needed to evaluate the longterm efficiency of this method and to explain the exact mechanism of action. Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity _Low-level lasers: He-Ne laser The He-Ne laser has a wavelength of 633 nm (Moritz et al. 2006) and is a low-level laser. The first application of the He-Ne laser in the therapy of dentine hypersensitivity was described by Senda et al. (1985), who used an output power of 6 mW and chose two different modes (cw and pulsed, 5 Hz). Effectiveness ranged from 5 to 100 %. In another study, an effectiveness of 5 to 18 % was achieved (Wilder-Smith 1988). To date, the mechanism of action of the He-Ne laser has not been explained completely (Moritz et al. 2006). An energy level of 6 mW does not alter the enamel or dentinal surface structure morphologically; however, laser energy transmits through enamel and dentine and reaches the pulp tissue (Watanabe 1993). Physiological experiments have shown that the He-Ne laser application does not influence nociceptors of circumferential A– or C-fibres (Jarvis et al. 1990), but it does influence electrical activity (action potential), which in healthy nerves is enhanced by about 33 % after application (Rochkind et al. 1986). The effect is long-lasting and leads to an increase in the action potential of nerve fibres for more than eight months after laser application (Rochkind et al. 1986). _He-Ne laser compared to Nd:YAG laser In a clinical study (Gelsky et al. 1992), which was aimed at testing the effectiveness and confidence of the Nd:YAG laser in the therapy of dentine hypersensitivity in vivo (see below), the He-Ne laser was applied to one group and the He-Ne laser and the Nd:YAG laser were applied to the other group (30–100 mJ, 10 pps increments of ten to 40 seconds, total application time < two minutes, without local anaesthesia). Dentine hypersensitivity was measured mechanically (dental probe) and thermally (stream of cold air) with the aid of a VAS. Additionally, the pulpal sensibility was evoked electrically. Initially and after three months, X-rays were taken to identify possible side-effects of the laser application. Directly after laser application and three months later, a reduction in the level of discomfort was observed. After three months, dentine hypersensitivity evoked by thermal stimuli was scaled back to 63 % and hypersensitivity evoked by mechanical stimulation was scaled back to 61 %. Compared with the combined application of He-Ne and Nd:YAG lasers, there was not much difference (reduction of dentine hypersensitivity evoked by thermal stimulation to 58 %; evoked by mechanical stimulation to 61 %). All of the teeth were vital after application and no side-effects or complications could be detected. If dentine hypersensitivity is conditioned by the hydrodynamic mechanism exclusively, (thermal) effects of Nd:YAG laser application should reduce dentine hypersensitivity primarily (Gelsky et al. 1992). In contrast, He-Ne laser application should not lead to important effects. Thus, it is assumed that a surficial modification is not the only desensitising factor, but that there is apparently also a neurophysiological component (Gelsky et al. 1992), which is affected by biostimulative effects. In a study with a similar design, the reduction of dentine hypersensitivity after He-Ne laser application alone, as well as after combined He-Ne laser and Nd:YAG laser application, was detected. It remained stable for six weeks (Halket et al. 1996)._ Editorial note: To be continued in our next issue of Laser. A list of references is available from the publisher. Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity overview I I 25 laser 1_2012 Dr Ute Botzenhart Department of Orthodontics Centre of Dentistry and Oral Health Ernst Moritz Arndt University of Greifswald Germany Dr Andreas Braun/Prof Matthias Frentzen Department of Periodontology, Operative and Preventive Dentistry University of Bonn Germany _contact laser Botzenhart, U.,Braun, A., & Frentzen, M. (2012). Laser treatment of dentine hypersensitivity

Title

Your Name

Chamberlain College of Nursing

NR451 RN Capstone Course

Term and Year

Your title here

This paragraph(s) is to introduce the paper.
Explain the type of work setting you are discussing and whether interprofessional teams are present. If present, indicate a team function that could be improved.  If not present, indicate what type of team you think might work well in this setting and how it might function.
Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper.

NR451_iCARE_paper_outline_template__Wk_5

Compassion

In this paragraph, describe
a nursing action that could contribute to compassion
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Advocacy

In this paragraph, describe
a nursing action that could contribute to advocacy
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Resilience

In this paragraph, describe
a nursing action that could contribute to resilience
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Evidence-Based Practice

In this paragraph, describe
a nursing action that could contribute to evidence-based

practice
through interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Summary

Provide a clear and concise summary. Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes through nursing actions.  Address how you may be able to influence this process of support for interprofessional teams on your unit or in your organization.

 

References

Select at least one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional.

Getting Started: Interprofessional teams are part of practice trends we see developing in all aspects of care delivery. Consider you own work environment (or recent clinical setting).

For this assignment, consider the concept of interprofessional teamwork and patient outcomes.

Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.)

Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)

iCARE components are:

C ompassion

A dvocacy

R esilience

E vidence-Based Practice (EBP)

How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?

Select one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional.

Use APA format throughout, particularly in citations and on the References page.

Please paraphrase throughout. One short quote is permitted.

The prepared
paper template
is RECOMMENDED for this assignment.

 

 

 

 

 

 

Title

Your Name

Chamberlain College of Nursing

NR451 RN Capstone Course

Term and Year

 

 

Your title here

This paragraph(s) is to introduce the paper.
Explain the type of work setting you are discussing and whether interprofessional teams are present. If present, indicate a team function that could be improved.  If not present, indicate what type of team you think might work well in this setting and how it might function.
Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper.

Compassion

In this paragraph, describe
a nursing action that could contribute to compassion
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Advocacy

In this paragraph, describe
a nursing action that could contribute to advocacy
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Resilience

In this paragraph, describe
a nursing action that could contribute to resilience
through interprofessional team support; describe how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Evidence-Based Practice

In this paragraph, describe
a nursing action that could contribute to evidence-based

practice
through interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

Summary

Provide a clear and concise summary. Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes through nursing actions.  Address how you may be able to influence this process of support for interprofessional teams on your unit or in your organization.

 

References

Select at least one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional.

Article One

 

Title

 

Ely J. T. A., Mercury Induced Alzheimer’s Disease: Accelerating Incidence?

 

Purpose

 

The purpose of the study is to determine whether the mercury contained within amalgam restorations increased the likelihood of acquiring Alzheimer’s disease.  The study seeks to bring into light the connection between a condition called micromercurialism, a form of mercury poisoning following low-dose mercury exposure over a prolonged period of time, and amalgam. The study will attempt to support the controversial claim that micromercurialism is one of the main causes of Alzheimer’s disease.

 

Methods

 

The amount of mercury (Hg°) released from amalgams was determined using a Jeronome Model 411 Mercury Vaporizer Analyzer powered by a portable battery. Subjects used in the study were found in a meeting on mental illness and had either requested to participate in the study or consented to it. An initial mercury reading was obtained 30 seconds prior to a gum chewing session and then again after the gum chewing session (for this reading, the participant’s teeth was dried and the participant was asked to hold his or her breath for 10 seconds). By blowing air into the mercury vaporizer, the mercury level contained within the air sample could be determined and displayed as a digital readout. Mercury levels were compared before and after gum chewing (by blowing air into a mercury vaporizer) for two participants.

 

 

 

 

 

Results

 

The study supported the notion that mercury is released from amalgam restorations. Mercury vapour content post gum chewing was at least four times higher than that found before gum chewing. When an individual is chewing gum, mercury-containing vapour is produced in the oral cavity and the individual could then inhale this vapour. Other studies had similar findings; for example, one study-examining cadavers showed that individuals with amalgam restorations had higher levels of mercury in the nucleus basalis of Meynert as compared to individuals without amalgam restorations. It is suggested that perhaps amalgam results in increased incidence of Alzheimer’s disease because the presence of mercury induces the activity of mercury-inactivating enzymes. Mercury-inactivating enzymes have been implicated in slowing down natural neural processes, and thus may be responsible for causing Alzheimer’s disease.

 

Critique

 

Since the sample size was extremely small containing only two subjects, the results obtained cannot be extrapolated to the general population with a high degree of confidence. Increasing sample size would make the results obtained more reliable. Moreover, since the two participants used did not have Alzheimer’s disease, the study cannot conclude directly that mercury from amalgam restorations causes Alzheimer’s disease; rather the study can only claim that the mercury within amalgam restorations can be released into a vapour following chewing. To conclude that amalgam restorations result in increased incidence of Alzheimer’s disease, a long-term study would need to be conducted and the incidence of Alzheimer’s disease in this group would need to be significantly higher than that found in the general population. If empirical evidence supported the idea that amalgam restorations cause Alzheimer’s disease, it would permanently change how dentistry is practiced.

 

Conclusion

 

Using two mental health patients, the study showed that following chewing, mercury could be released from amalgam restorations into the air contained within the oral cavity. However, it cannot be concluded definitively, based on this study that the mercury contained within amalgam restorations causes Alzheimer’s disease. To be able to make such a bold claim, a long-term study involving many individuals with amalgam restorations would need to be conducted, and the incidence level of Alzheimer’s disease would need to be much higher in this group than in the general population to support such a claim. Moreover, part of the author’s claim that the mercury contained within amalgam restorations causes Alzheimer’s disease is based on other studies each using a different set of methods.

How can liver and renal diseases result in abnormal uterine bleeding (AUB)?

 

a.

They cause an imbalance in platelet aggregation.

 

b.

They result in an inability to adequately clear estrogen from the body.

 

c.

They cause thyroid dysfunction, which leads to bleeding abnormalities.

 

d.

They result in elevated prolactin levels, which lead to bleeding abnormalities.

 

 

What is now thought to be the most important causative agent in cervical cancer?

 

a.

PCOS

 

b.

Vulvar cancer

 

c.

Herpes simplex

 

d.

HPV

 

 

An initial or primary genital herpes infection characteristically lasts about:

 

a.

1 week

 

b.

3 weeks

 

c.

1 month

 

d.

6 weeks

 

 

Which contraceptive methods have inherent failure rates?

 

a.

None

 

b.

Some

 

c.

All

 

d.

All except sterilization

 

Why do adolescents have the highest risk of developing pelvic inflammatory disease (PID)?

 

a.

They have the highest risk for bacterial vaginosis.

 

b.

They are the least at risk for developing other STIs.

 

c.

They are the most sexually active.

 

d.

They have decreased immunity to infectious organisms.

 

Exercise-induced amenorrhea is probably due to the combination of low body fat and decreased secretion of:

 

a.

Estrogen

 

b.

Prolactin

 

c.

Progesterone

 

d.

GnRH

 

What can result from an imbalance in the vaginal flora?

 

a.

Herpes simplex virus

 

b.

Human papillomavirus

 

c.

Chlamydia

 

d.

Bacterial vaginosis

 

The most effective means of obtaining the history of abuse is to use a communication model that:

 

a.

Avoids having the patient’s children present during the discussion

 

b.

Signals someone is interested and that the woman is not alone

 

c.

Emphasizes the belief that violence is not acceptable, no matter what the batterer might have said to the patient

 

d.

Allows the patient to talk without interruption and with time to relate, emphasize, and repeat her full story

 

What is the most common STI in the United States?

 

a.

Gonorrhea

 

b.

Chlamydia

 

c.

Syphilis

 

d.

Herpes simplex virus

 

 

Progestin-only pills (POPs):

 

a.

Have no possible side effects

 

b.

Suppress ovulation as reliably as COCs

 

c.

May be taken earlier or later than prescribed

 

d.

In combination with lactation are nearly 100% effective

 

 

According to the World Health Organization (WHO), the presence of a disease state:

 

a.

Necessitates prompt medical attention

 

b.

Excludes a person from being considered healthy

 

c.

Does not exclude a person from being considered healthy

 

d.

Classifies a person as in poor health

 

 

Which of the following might be a sign of hyperandrogenism?

 

a.

Irritable bowel syndrome

 

b.

Decreased sebum secretion in the skin

 

c.

Decreased muscle mass

 

d.

Acne associated with menstrual dysfunction

 

Surgical abortion represents an option for women who desire termination of pregnancy beyond:

 

a.

8 weeks’ gestation

 

b.

12 weeks’ gestation

 

c.

4 weeks’ gestation

 

d.

15 weeks’ gestation

 

How can weight loss specifically control symptoms of polycystic ovary syndrome (PCOS)?

 

a.

It decreases SHBG.

 

b.

It increases insulin resistance.

 

c.

It decreases androgen levels.

 

d.

It increases estrogen levels.

 

 

Why is acknowledging the oppression of women more difficult within Western societies?

 

a.

The multiplicity of minority groups complicates the issue.

 

b.

The availability of health care makes acknowledgment more difficult.

 

c.

The diversity of the news media clouds the issue.

 

d.

Affluence and increased opportunities mask oppression.

 

 

How does vaginosis differ from vaginitis?

 

a.

It must be treated with metronidazole.

 

b.

The discharge does not contain white blood cells.

 

c.

The discharge does not have an odor.

 

d.

It causes itching and/or burning.

 

 

What area of injury prevention is a focus of the USPSTF’s guidelines for counseling all healthy, asymptomatic women?

 

a.

Motor vehicle accidents

 

b.

Falls

 

c.

Domestic violence

 

d.

All of the above

 

 

What approach does Healthy People 2020 use to achieve its goals and objectives?

 

a.

Social determinants of health

 

b.

Evidence-based determinants of health

 

c.

Quality-of-life determinants of health

 

d.

Longevity promotion determinants of health

 

 

Approximately what percentage of women with bacterial vaginosis are asymptomatic?

 

a.

25%

 

b.

40%

 

c.

75%

 

d.

50%

 

The genetic counselor has a significant role in the care of women because BRCA1 and BRCA2 genetic mutations account for 5 to 10 percent of all _______ cancer cases.

 

a.

Breast

 

b.

Ovarian

 

c.

Uterine

 

d.

Pancreatic

Which organism causes 90% of vulvovaginal candidiasis episodes in women?

 

a.

Candida tropicalis

 

b.

Candida albicans

 

c.

Candida glabrata

 

d.

Candida krusei

 

What term refers to the period from about 7 to 10 days before menstrual flow begins until the first or second day of menstrual flow?

 

a.

Amenorrhea

 

b.

Premenstrual

 

c.

Dysmenorrhea

 

d.

Perimenstrual

 

The ParaGard IUD is impregnated with copper and is effective for:

 

a.

15 years

 

b.

3 years

 

c.

5 years

 

d.

10 years

 

What is the danger of giving estrogen replacement therapy (ERT) to menopausal women with an intact uterus?

 

a.

A higher risk of heart disease

 

b.

An increased likelihood of blood clots

 

c.

An increased likelihood of osteoporosis

 

d.

A higher risk of endometrial cancer

 

Although barrier contraception methods are less effective in preventing pregnancy than more modern methods, interest in them is on the rise because they:

 

a.

Can help protect against STIs, including HIV

 

b.

Are coitus dependent and require planning

 

c.

Are nonallergenic and male controlled

 

d.

Involve the use of hormones

 

A risk factor that could lead to endometrial cancer is:

 

a.

Early menopause

 

b.

Late menopause

 

c.

High blood pressure

 

d.

Cervical cancer

 

Of the two intrauterine contraceptive devices currently available in the United States only one provides a local delivery of protestin. It is the:

 

a.

Combined contraceptive patch (Ortho Evra)

 

b.

Copper IUD (T380A, ParaGard)

 

c.

LNG-IUS (Mirena)

 

d.

Dalkon Shield

 

Approximately what percentage of vulvar cancers occur in women older than the age of 50?

 

a.

50%

 

b.

70%

 

c.

85%

 

d.

60%

 

What is the best definition of abnormal uterine bleeding (AUB)?

 

a.

Uterine bleeding for which no pelvic pathology is found

 

b.

Uterine bleeding that is irregular during a woman’s menstrual cycle

 

c.

Uterine bleeding that is irregular in amount or frequency

 

d.

Uterine bleeding that is related to systemic conditions

 

The most common benign breast masses are:

 

a.

Galactoceles

 

b.

Hamartomas

 

c.

Fibroadenomas and cysts

 

d.

Lipomas and phyllodes tumors

 

Which cancer has the highest mortality rate of all gynecological cancers?

 

a.

Vulvar cancer

 

b.

Endometrial cancer

 

c.

Cervical cancer

 

d.

Ovarian cancer

 

Vulvovaginal candidiasis accounts for what percentage of all vaginal infections?

 

A.

10–15%

 

B.

20–25%

 

C.

50–55%

 

D.

60–65%

 

Which type of counseling results in a statistically significant reduction in STIs?

 

a.

Abstinence-only education

 

b.

Counseling delivered in multiple individual or group sessions totaling more than 3 hours

 

c.

Remote counseling via Internet or phone

 

d.

Brief, individual sessions in the primary care setting

 

Which of the following is an ethical issue that is specifically associated with pre-implantation testing with ART?

 

a.

Ownership of frozen embryos after the couple has divorced

 

b.

A surrogate deciding she does not want to relinquish the infant

 

c.

Genetic engineering and the ability to reject embryos affected by inherited disorders

 

d.

The implantation of multiple embryos, which can create high risk for the embryos and the woman

 

What symptom is present in 80 to 90 percent of women with cervical cancer?

 

a.

Abnormal vaginal bleeding

 

b.

Abnormal vaginal discharge

 

c.

Pelvic pain

 

d.

Ectopic pregnancy

 

If a patient has not reported a sexual assault to law enforcement, all of the following clinician actions are important except:

 

a.

Asking if reporting is something she wants to consider

 

b.

Discussing any fears or concerns that she may have about reporting

 

c.

Explaining that only some forced sexual contacts are reportable crimes

 

d.

Telling her that women who report do better psychologically than those who do not

 

What test should be ordered for a woman who is experiencing abnormal uterine bleeding (AUB) as well as headaches and peripheral vision changes?

 

a.

Thyroid-stimulating hormone test

 

b.

Nucleic acid amplification test

 

c.

Complete blood count

 

d.

Prolactin level test

 

What had been a significant problem in medical research well into the 1990s?

 

a.

The focus on randomized clinical trials over epidemiological investigations

 

b.

The lack of representation of women in research trials

 

c.

The lack of research related to gynecology

 

d.

The focus on randomized clinical trials over observational research

 

What is the definitive diagnostic technique for vulvar dermatoses?

 

a.

Pap test

 

b.

Biopsy

 

c.

Colposcopy

 

d.

Physical exam

 

Where in the breast do most malignancies develop?

 

a.

Upper inner quadrant

 

b.

Upper outer quadrant

 

c.

Lower outer quadrant

 

d.

Lower inner quadrant

 

Approximately how many Americans will contract one or more sexually transmitted infections during their lifetime?

 

a.

50%

 

b.

25%

 

c.

40%

 

d.

60%

 

In the GTPAL system for recording pregnancy history, the “T” stands for:

 

a.

Term births

 

b.

Terminal pregnancies

 

c.

Total number of pregnancies

 

d.

Type of birth (spontaneous, assisted, or cesarean)

 

Both very young and elderly sexual assault victims:

 

a.

Are addressed in most state mandatory reporting laws

 

b.

never has any difficulty describing the incident and related symptoms

 

c.

Require the same equipment for proper examination that others do

 

d.

Have fewer injuries than victims of other age groups

 

What is one of the side effects of hormonal contraceptives?

 

a.

Reduction in ovarian cancer risk

 

b.

Increased menstrual blood loss

 

c.

Increased risk of endometrial cancer

 

d.

Heavier menstrual flow

 

Tubal sterilization for women who have completed their families is highly effective, but there are disadvantages such as:

 

a.

Women are less likely to use condoms or return for health services.

 

b.

There is a decreased risk of ovarian cancer and pelvic inflammatory disease.

 

c.

There is a high likelihood of complications and side effects.

 

d.

The surgery is not covered by insurance.

 

What is the current (2006) recommendation by the CDC regarding HIV testing?

 

a.

Test all patients who report risk behaviors associated with HIV.

 

b.

Test all patients unless they explicitly decline to be tested.

 

c.

Test all patients.

 

d.

Test only those patients who ask to be tested.

 

What is generally the cause of Bartholin’s cyst?

 

a.

Complications from gonorrhea

 

b.

Cystic fluid in Bartholin’s gland becomes infected

 

c.

A fungal infection in Bartholin’s gland

 

d.

Obstruction of a duct in Bartholin’s gland

 

Which of the following factors associated with increased risk for developing osteoporosis appears to be the best predictor of risk?

 

a.

Smoking

 

b.

Low body weight

 

c.

Sedentary lifestyle

 

d.

Family history

 

What is the definition of primary amenorrhea?

 

a.

The cessation of menses for an interval of 6 months

 

b.

The failure to begin menses by age 14

 

c.

The cessation of menses due to outflow tract obstruction

 

d.

The failure to begin menses by age 16

 

In respect to an evidentiary examination:

 

a.

The patient may not withhold consent if the clinician is a mandated reporter.

 

b.

The clinician is required to strictly follow local agency protocols, no others.

 

c.

The time frame within which it must take place depends on local standards.

 

d.

Maintaining the chain of custody of all evidence collected is recommended, not required.

QUESTION 1

Which of the following is a diagnostic label that is listed in the Diagnostic and Statistical Manual IV-TR?

a.

Premenstrual dysphoric disorder

b.

Premenstrual magnification

c.

Dysmenorrhea

d.

Premenstrual syndrome

About half of all pregnancies in the United States are unintended and occur most frequently in women who:

a.

Are married or divorced

b.

Have finished high school

c.

Are between the ages of 18 and 24

d.

Are members of the majority group

 

 

 

 

What is one factor that can reduce the risk for the development of ovarian cancer?

 

a.

Multiple pregnancies

 

b.

Transvaginal ultrasounds

 

c.

Identification of recurrence

 

d.

Weight loss

 

 

What percentage of toxic shock syndrome cases are related to menses?

 

a.

50%

 

b.

25%

 

c.

75%

 

d.

90%

Tubal sterilization for women who have completed their families is highly effective, but there are disadvantages such as:

 

a.

Women are less likely to use condoms or return for health services.

 

b.

There is a decreased risk of ovarian cancer and pelvic inflammatory disease.

 

c.

There is a high likelihood of complications and side effects.

 

d.

The surgery is not covered by insurance.

 

Women who report experiencing the most severe symptoms of PMS tend to be: In their late 40s

a.

In their late 40s

b.

In their early 20s

c.

In their late teens

d.

In their late 30s

What is the definition of primary amenorrhea?

 

a.

The cessation of menses for an interval of 6 months

 

b.

The failure to begin menses by age 14

 

c.

The cessation of menses due to outflow tract obstruction

 

d.

The failure to begin menses by age 16

How many stages does the Tanner scale use to stage sexual maturity?

 

a.

3 stages

 

b.

5 stages

 

c.

6 stages

 

d.

8 stages

 

Which contraceptive methods have inherent failure rates?

a.

None

b.

Some

c.

All

d.

All except sterilization

What is the most common type of menstrual dysfunction related to hyperandrogenism?

 

a.

Painful menstruation

 

b.

Absence of menses

 

c.

Irregular bleeding

 

d.

Early menopause

 

Combined oral contraceptives (COCs) are among the most extensively studied medications available. Which one of the following statements about their use has been found to be true?

 

a.

Broad-spectrum antibiotics may enhance their efficacy.

 

b.

They do not increase the risk of venous thromboembolism.

 

c.

They decrease the relative risk of ovarian and endometrial cancers.

 

d.

Among possible side effects are acne, hirsuitism, and benign breast conditions.

 

Many patients experiencing intimate partner violence (IPV) meet the criteria for diagnosing PTSD. Those criteria include all of the following except:

a.

Experiencing a traumatic event

b.

Reexperiencing the traumatic event

c.

Numbness and avoidance

d.

Hypovigilance

Which of the following is an ethical issue that is specifically associated with pre-implantation testing with ART?

a.

Ownership of frozen embryos after the couple has divorced

b.

A surrogate deciding she does not want to relinquish the infant

c.

Genetic engineering and the ability to reject embryos affected by inherited disorders

d.

The implantation of multiple embryos, which can create high risk for the embryos and the woman

The ________ is probably the most widely used intimate partner violence (IPV) screen.

 

a.

Three-question AAS (McFarlane et al., 1992)

 

b.

Campbell’s Danger Assessment (2003)

 

c.

Sheridan’s HARASS Instrument

 

d.

Helton’s nine-question AAS

 

What is the term for the absence of menses for 3 to 6 months in a woman who has previously menstruated and is not pregnant, breastfeeding, or menopausal?

a.

Primary amenorrhea

b.

Initial dysmenorrhea

c.

Secondary amenorrhea

d.

Primary dysmenorrhea

Among women age 55 years and older:

 

a.

Macromastia is the most common cause of breast masses.

 

b.

Breast masses are presumed malignant until proven otherwise.

 

c.

Most breast masses decrease in size over time and many resolve completely.

 

d.

Diagnostic imaging of a breast mass and tissue sampling should be deferred.

 

Both very young and elderly sexual assault victims:

a.

Are addressed in most state mandatory reporting laws

b.

never has any difficulty describing the incident and related symptoms

c.

Require the same equipment for proper examination that others do

d.

Have fewer injuries than victims of other age groups

What is the major source of normal vaginal secretions?

 

a.

Bartholin’s glands

 

b.

Apocrine glands

 

c.

Sebaceous glands

 

d.

Cervical mucosa

 

Which one of the following statements about intimate partner violence (IPV) is false?

a.

It refers to an escalating pattern of abuse.

b.

It includes emotional abuse, such as disregarding what a woman wants.

c.

It includes using physical force to make a woman engage in a sexual act against her will.

d.

It refers to a current or former spouse or dating partner of the opposite sex, not someone of the same sex.

How is being overweight defined on the BMI table?

 

a.

18–29.9

 

b.

20–29.9

 

c.

25–29.9

 

d.

30 or greater

 

What has contributed to the decreased incidence of hepatitis B over the past 20 years?

a.

The decrease in PID

b.

The HBV vaccination

c.

The increase in condom use

d.

More precise screening methods

 

Which are the most common forms of hepatitis seen in women’s health practices?

 

a.

A and B

 

b.

A and D

 

c.

B, C, and D

 

d.

B and C

The factors that enable women to enjoy and control their sexual and reproductive lives, including a physical and emotional state of well-being and the quality of sexual and other close relationships, make up a woman’s:

a.

Sexual health

b.

Gender identity

c.

Gender role behaviors

d.

Psychosocial orientation

What test should be ordered for a woman who is experiencing abnormal uterine bleeding (AUB) as well as headaches and peripheral vision changes?

 

a.

Thyroid-stimulating hormone test

 

b.

Nucleic acid amplification test

 

c.

Complete blood count

 

d.

Prolactin level test

 

Surgical abortion represents an option for women who desire termination of pregnancy beyond:

a.

8 weeks’ gestation

b.

12 weeks’ gestation

c.

4 weeks’ gestation

d.

15 weeks’ gestation

What population of women should be screened for signs and symptoms of thyroid dysfunction?

a.

All women

b.

Older women

c.

Older women, smokers, and women with diabetes

d.

Older women, postpartum women, and women with Down syndrome

 

All of the following diagnostic testing and procedures are now infrequently performed in clinical practice except:

a.

Hysterosalpingogram

b.

Sperm penetration assay

c.

The postcoital test (PCT)

d.

Endometrial biopsy (EMB)

 

The most common site for endometrial implants found in other parts of the body is:

a.

The appendix

b.

The uterus

c.

The ovaries

d.

The fallopian tubes

Women who have had toxic shock syndrome should be instructed not to use tampons or:

 

a.

Barrier contraception methods

 

b.

Hormonal contraception methods

 

c.

Intravaginal antibiotic cream

 

d.

Oral antibiotics

Cyclic mastalgia:

 

a.

More likely causes unilateral, localized pain that is sharp or burning in nature

 

b.

Has an increased risk of occurrence in women whose diets are low in fat

 

c.

Occurs most frequently in women who are 18 to 30 years old

 

d.

Is caused by hormonal changes associated with menstruation

The incidence of uterine fibroids:

a.

Increases with age

b.

Decreases with age

c.

Is often caused by early menopause

d.

Is related to the age of first menses

Patients presenting for STI treatment should be screened for HIV:

 

a.

At each visit

 

b.

At the end of treatment

 

c.

At the beginning of treatment

 

d.

Each year

What screening recommendation is similar across all groups for colorectal cancer?

a.

Screening women age 76 to 85 based on risk factors

b.

Screening only for those women at increased risk

c.

Screening for all women starting at age 50

d.

Against routine screening in adults age 76 and over

 

Approximately what percentage of vulvar cancers occur in women older than the age of 50?

 

a.

50%

 

b.

70%

 

c.

85%

 

d.

60%

 

Signs of endometrial or cervical cancer may present abnormal uterine bleeding, often as heavy, prolonged bleeding or:

a.

Menometrorrhagia

b.

Amenorrhea

c.

Oligomenorrhea

d.

Polymenorrhea

 

In the GTPAL system for recording pregnancy history, the “T” stands for:

 

a.

Term births

 

b.

Terminal pregnancies

 

c.

Total number of pregnancies

 

d.

Type of birth (spontaneous, assisted, or cesarean)

What is now thought to be the most important causative agent in cervical cancer?

 

a.

PCOS

 

b.

Vulvar cancer

 

c.

Herpes simplex

 

d.

HPV

 

The most common sites of metastatic spread of invasive breast cancer include all of the following except:

a.

Bones

b.

Lungs

c.

Pituitary

d.

Lymph nodes

Who should be screened regularly for STIs?

 

a.

Women who have more than one sexual partner

 

b.

Women over the age of 21

 

c.

Women who are sexually active

 

d.

Women over the age of 15

 

What is a common vasomotor symptom of menopause?

a.

Blood clots

b.

Night sweats

c.

Osteoporosis

d.

Hysterectomy

 

What is the best definition of abnormal uterine bleeding (AUB)?

 

a.

Uterine bleeding for which no pelvic pathology is found

 

b.

Uterine bleeding that is irregular during a woman’s menstrual cycle

 

c.

Uterine bleeding that is irregular in amount or frequency

 

d.

Uterine bleeding that is related to systemic conditions

What should be the clinician’s first objective after learning the chief reason the woman desires care?

 

a.

To give the reason or problem a structural and chronological framework

 

b.

To probe for any additional concerns missed

 

c.

To take a family history related to the presenting concern

 

d.

To gain insight into the woman’s cultural and social influences

No risk factors other than age are identifiable in ______ of women with breast cancer.

 

a.

100%

 

b.

85%

 

c.

60%

 

d.

24%

The highest prevalence of human papillomavirus (HPV) is found among women ages:

 

a.

18–20

 

b.

20–24

 

c.

25–30

 

d.

30–35

Although barrier contraception methods are less effective in preventing pregnancy than more modern methods, interest in them is on the rise because they:

 

a.

Can help protect against STIs, including HIV

 

b.

Are coitus dependent and require planning

 

c.

Are nonallergenic and male controlled

 

d.

Involve the use of hormones