Tag: Clinical-Nursing

  • Develop foreground clinical question using PICOT format

    Develop foreground clinical question using PICOT format.

    Student Level 🙁 2
    nd
    Year Master- Medical-Surgical)

    Student Name:

    Student Number:

    ORDER A PLAGIARISM-FREE PAPER HERE

    My Research Questio
    n
    :

    Effect of an Osteoporosis Educational Intervention on knowledge and compliance to osteoporosis prevention activities in female students in king Abdul-Aziz university

     

    Develop your background question

    How does the Osteoporosis Educational Intervention work to affect osteoporosis knowledge and compliance to osteoporosis prevention activities? Develop foreground clinical question using PICOT format

     

    Develop foreground clinical question using PICOT format.

    P:            Young women, age 18-24 years, students attending King Abdul-Aziz University

    I:            Osteoporosis educational intervention

    C:           Current Osteoporosis beliefs, knowledge and behaviors

    O:           Osteoporosis knowledge and compliance to osteoporosis prevention activities.

    T:            One month

    Develop foreground clinical question using PICOT format

     

    In young adult collegiate female, how dose an Osteoporosis educational intervention compared to Current Osteoporosis beliefs, knowledge and behaviors affect Osteoporosis knowledge and compliance to osteoporosis prevention activities over one-month?

     

    Identify the type of foreground question that you developed.

    The type of foreground question is Intervention Questions. Develop foreground clinical question using PICOT format.

     

     

    Identify the type of evidence that can answer your clinical question.

     

    The evidence requires to answer this type of question is cause and effect relationship (RCT) Develop foreground clinical question using PICOT format

  • Influencing Social Change for psychiatric mental health

    Influencing Social Change for psychiatric mental health

    Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.

    Learning Objectives

    ORDER A PLAGIARISM-FREE PAPER HERE

    Students will: Apply strategies to become a social change agent for psychiatric mental health

    Required Readings

    Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full Influencing Social Change for psychiatric mental health

    Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

    Note: Retrieved from from the Walden Library databases.

    Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx Influencing Social Change for psychiatric mental health

    Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

    Note: Retrieved from from the Walden Library databases.

    Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

    Note: Retrieved from from the Walden Library databases.

    To prepare for this Discussion:

    Reflect on how you might influence social change for psychiatric mental health.

    Question

    An explanation of how you, as a nurse practitioner, might become a social change agent for psychiatric mental health. Include how you might advocate for change within your own community Influencing Social Change for psychiatric mental health

  • NRS-451 quality improvement initiative Executive Summary

    Executive Summary

    NRS-451 quality improvement initiative Executive Summary

    In this assignment, you will propose a quality improvement initiative from your place of employment that could easily be implemented if approved. Assume you are presenting this program to the board for approval of funding. Write an executive summary (750-1,000 words) to present to the board, from which the board will make its decision to fund your program or project. Include the following:

    The purpose of the quality improvement initiative.

    The target population or audience.

    The benefits of the quality improvement initiative.

    The interprofessional collaboration that would be required to implement the quality improvement initiative.

    The cost or budget justification. NRS-451 quality improvement initiative Executive Summary

    The basis upon which the quality improvement initiative will be evaluated.

    Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

    ORDER A PLAGIARISM-FREE PAPER HERE

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

    Course Code

    Class Code

    Assignment Title

    Total Points

    NRS-451VN

    NRS-451VN-O502

    Executive Summary

    140.0

    Criteria

    Percentage

    Unsatisfactory (0.00%)

    Less Than Satisfactory (75.00%)

    Satisfactory (79.00%)

    Good (89.00%)

    Excellent (100.00%)

    Content

    80.0%

    Purpose of the Quality Improvement Initiative

    15.0%

    The purpose of the quality improvement initiative is not provided.

    The purpose of the quality improvement initiative is incomplete, missing relevant information.

    The purpose of the quality improvement initiative is provided and meets the basic criteria for the assignment as indicated in the assignment instructions.

    The purpose of the quality improvement initiative meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

    The purpose of the quality improvement initiative meets all criteria for the assignment, as indicated in the assignment instructions, is provided in detail, and demonstrates higher level thinking by incorporating prior learning or reflective thought.

    Target Population or Audience

    13.0%

    The target population or audience is not addressed.

    The target population or audience is incomplete, missing relevant information.

    The target population or audience is provided and meet the basic criteria for the assignment as indicated in the assignment instructions.

    The target population or audience meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

    The target population or audience meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

    Benefits of Quality Improvement Initiative

    13.0%

    The benefits of the quality improvement initiative are not provided. NRS-451 quality improvement initiative Executive Summary

    The benefits of the quality improvement initiative are incomplete, missing relevant information.

    The benefits of the quality improvement initiative are provided and meet the basic criteria for the assignment as indicated in the assignment instructions.

    The benefit of the quality improvement initiative meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

    The benefit of the quality improvement initiative meet all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

    Interprofessional Collaboration Required to Implement the Quality Improvement Initiative

    13.0%

    The interprofessional collaboration that would be required to implement the quality improvement initiative is not discussed.

    The interprofessional collaboration that would be required to implement the quality improvement initiative is incomplete, missing relevant information.

    The interprofessional collaboration that would be required to implement the quality improvement is discussed and meets the basic criteria for the assignment as indicated in the assignment instructions

    The interprofessional collaboration that would be required to implement the quality improvement is discussed and meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

    The interprofessional collaboration that would be required to implement the quality improvement initiative is clearly discussed and meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

    Cost or Budget Justification

    13.0%

    The cost or budget justification is not provided.

    The cost or budget justification is incomplete, missing relevant information.

    The cost or budget justification is provided and meets the basic criteria for the assignment as indicated in the assignment instructions.

    The cost or budget justification issue meets all criteria for the assignment, as indicated in the assignment instructions, and is provided in detail.

    The cost or budget justification issue meets all criteria for the assignment, as indicated by the assignment instructions, and is provided in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

    Basis Upon Which the Program or Project Will Be Evaluated

    13.0%

    The basis upon which the quality improvement initiative will be evaluated is not provided.

    The basis upon which the quality improvement initiative will be evaluated is incomplete, missing relevant information.

    The basis upon which the quality improvement initiative will be evaluated meets the basic criteria for the assignment as indicated in the assignment instructions.

    The basis upon which the quality improvement initiative will be evaluated is provided in detail.

    The basis, upon which the quality improvement initiative will be evaluated as indicated by the assignment instructions, is provided in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.

    Organization, Effectiveness, and Format

    20.0%

    Thesis Development and Purpose

    5.0%

    Paper lacks any discernible overall purpose or organizing claim.

    Thesis is insufficiently developed or vague. Purpose is not clear.

    Thesis is apparent and appropriate to purpose.

    Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

    Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

    Paragraph Development and Transitions

    NRS-451 quality improvement initiative Executive Summary

    5.0%

    Paragraphs and transitions consistently lack unity and coherence.  No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope.  Organization is disjointed.

    Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

    Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

    A logical progression of ideas between paragraphs is apparent.  Paragraphs exhibit a unity, coherence, and cohesiveness.  Topic sentences and concluding remarks are appropriate to purpose.

    There is a sophisticated construction of paragraphs and transitions.  Ideas progress and relate to each other.  Paragraph and transition construction guide the reader.  Paragraph structure is seamless.

    Mechanics of Writing  (includes spelling, punctuation, grammar, language use)

    5.0%

    Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

    Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

    Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

    Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

    Writer is clearly in command of standard, written, academic English.

    Paper Format  (use of appropriate style for the major and assignment)

    2.0%

    Template is not used appropriately, or documentation format is rarely followed correctly.

    Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

    Appropriate template is used. Formatting is correct, although some minor errors may be present.

    Appropriate template is fully used. There are virtually no errors in formatting style.

    All format elements are correct.

    Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

    3.0%

    Sources are not documented.

    NRS-451 quality improvement initiative Executive Summary

    Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

    Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

    Sources are documented, as appropriate to assignment and style, and format is mostly correct.

    Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

    Total Weightage

    100%

    NRS-451 quality improvement initiative Executive Summary

  • Off-Label Drug Use in Pediatrics Essay Assignment

    Off-Label Drug Use in Pediatrics Essay Assignment

    Week 11: Pediatrics

    Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

    BUY A PLAGIARISM-FREE PAPER HERE

    This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings. Off-Label Drug Use in Pediatrics Essay Assignment.

    Learning Objectives

    Students will:

    Evaluate the practice of prescribing off-label drugs to children

    Analyze strategies to make the off-label use of drugs safer for children

    Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

    Learning Resources

    Required Readings (click to expand/reduce)

     

    Required Media (click to expand/reduce)

     

    Assignment: Off-Label Drug Use in Pediatrics

    The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

    When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Off-Label Drug Use in Pediatrics Essay Assignment

    Photo Credit: Getty Images

    Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

    To Prepare

    Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders. Off-Label Drug Use in Pediatrics Essay Assignment

    Reflect on situations in which children should be prescribed drugs for off-label use.

    Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

    By Day 5 of Week 11

    Write 
    a 1-page narrative in APA format that addresses the following:

    Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

    Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

    Reminder:
     The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at 
    http://writingcenter.waldenu.edu/57.htm
    ). All papers submitted must use this formatting. Off-Label Drug Use in Pediatrics Essay Assignment.

    Submission and Grading Information

    To submit your completed Assignment for review and grading, do the following:

    Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.

    Click the 
    Week 11 Assignment Rubric 
    to review the Grading Criteria for the Assignment.

    Click the 
    Week 11 Assignment 
    You will also be able to “View Rubric” for grading criteria from this area.

    Next, from the Attach File area, click on the 
    Browse My Computer
    Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click 
    Open
    . Off-Label Drug Use in Pediatrics Essay Assignment

    If applicable: From the Plagiarism Tools area, click the checkbox for 
    I agree to submit my paper(s) to the Global Reference Database
    .

    Click on the 
    Submit
    button to complete your submission.

    Grading Criteria

    To access your rubric:

    Week 11 Assignment Rubric

     

    Check Your Assignment Draft for Authenticity

    To check your Assignment draft for authenticity: Off-Label Drug Use in Pediatrics Essay Assignment

    Submit your Week 11 Assignment draft and review the originality report.

     

    Submit Your Assignment by Day 7 of Week 11

    To participate in this Assignment:

    Week 11 Assignment

     

    Final Exam

    This Exam covers the content you have explored throughout this course.

    This exam is a test of your knowledge in preparation for your certification exam. 
    No outside resources
    —including books, notes, websites, or any other type of resource—are to be used to complete this exam. You are not allowed to take screenshots or record the exam questions in any other format while taking the exam. You are expected to 
    comply with Walden University’s Code of Conduct
    .

    Photo Credit: Getty Images/Hero Images

    By Day 7 of Week 11

    Complete
     the Final Exam. You have 120 minutes to complete the exam. You may only attempt this exam once.

    Submission and Grading Information

    Complete the Exam by Day 7 of Week 11

    To Complete this Exam:

    Week 11 Exam

     

    Module in Review

    In this module,
     you evaluated the practice and circumstances of prescribing off-label drugs to children and analyzed the strategies used to make their use and dosage safer for children. After you have completed the Discussion and the Final Exam for this week, you have finished the course. Congratulations! 
    Please complete the Course Evaluation form and submit by Day 7.

    Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7. Off-Label Drug Use in Pediatrics Essay Assignment

  • Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

    Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

    The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

    In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

    ORDER A PLAGIARISM-FREE PAPER HERE

    To Prepare:

    Reflect on the four peer-reviewed articles you critically appraised in Module 4. Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

    Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

    The Assignment:
     (Evidence-Based Project)

    Part 5: Recommending an Evidence-Based Practice Change

    Create an 8- to 9-slide PowerPoint presentation in which you do the following:

    Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

    Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

    Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

    Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

    Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

    Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

    Add a lessons learned section that includes the following:

    A summary of the critical appraisal of the peer-reviewed articles you previously submitted

    An explanation about what you learned from completing the evaluation table (1 slide)

    An explanation about what you learned from completing the levels of evidence table (1 slide)

    An explanation about what you learned from completing the outcomes synthesis table (1 slide)

     

    Topic: Preventing Healthcare-Associated Infection ( HAIs) in my workplace

    Below are 4 journals to support a change in practice in my workplace

     

    Article 1- Ford, C., & Park, L. J. (2018) –Level 7

    Article 2- Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017)-Level 2

    Article 3 – Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018)-Level  4

    Article 4- Halm, M., & Sandau, K. (2018)-Level 1

     

     

    Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
    British Journal of Nursing
    , 
    27
    (20), 1164–1166.
    https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.20.1164

     

    Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
    BMC Infectious Diseases
    , 
    17
    , 1–9.
    https://doi-org.ezp.waldenulibrary.org/10.1186/s12879-016-2157-z

     

     

    Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
    Nurse Education Today
    , 
    63
    , 112–118.
    https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2018.01.022

    https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S0260691718300492?via%3Dihub

     

     

    Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
    American Journal of Critical Care
    , 
    27
    (4), 334–337. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727 Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

     

     

    Below are the research databases I used to conduct my research

     

    Walden University Library. (n.d.-b). Evidence -based practice research: CINAHL Search help.

    Retrieved September 6, 2019, from

    https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

     

    Library of Congress. (n.d.). Search /browse help-Boolean Operators and nesting

    Retrieved September 19, 2018, from,

    https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchKeyword.html

     

    Walden Library. (n.d.) PubMed: Getting Started. Retrieved September  19, 2019 from,
    https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pubmed/?otool=mnwullib

    Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

  • NURS 6521 Week 10: Infections and Hematologic Systems

    NURS 6521 Week 10: Infections and Hematologic Systems

    Week 10: Infections and Hematologic Systems

    Bacterial and viral infections may spread through the direct contact of bodily fluids such as blood or through vectors, who help to spread infections via the blood. When you think of infections and the hematologic system, what comes to mind?

    Infectious diseases, such as malaria, dengue, or other hemorrhagic fevers are some examples of infections that impact the hematologic system. However, disorders of the hematologic system, such as anemia or blood clotting factor disorders, can also have a deleterious effect on a patient’s health and well-being NURS 6521 Week 10: Infections and Hematologic Systems. As an advanced practice nurse, you will need to understand the different types of pharmacotherapeutics used to treat infections and disorders of the hematologic system as you work to enhance patient-centered approaches for safe, quality, and effective care.

    This week, you will examine infections and hematologic disorders, as well as the types of drugs used to treat aspects of these disorders or health systems.

    BUY A PLAGIARISM-FREE PAPER HERE

    Learning Objectives

    Students will:

    Evaluate patients for treatment of complex health issues

    Evaluate patients for treatment of infections. NURS 6521 Week 10: Infections and Hematologic Systems.

    Evaluate patients for treatment of hematologic disorders

    Analyze patient education strategies for the management and treatment of complex comorbidities

    Learning Resources

    Required Readings (click to expand/reduce)

     

    Required Media (click to expand/reduce)

     

    Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

    To Prepare

    Review the resources for this module and reflect on the different health needs and body systems presented.

    Review the complex case asisgned by your Instructor for this Discussion.

    Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected. NURS 6521 Week 10: Infections and Hematologic Systems.

    Photo Credit: Getty Images

    By Day 6 of Week 10

    Read
     a selection of your colleagues’ responses from Week 9 and 
    respond 
    to 
    at least two
     of your colleagues on 
    two different days
     who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6521 Week 10: Infections and Hematologic Systems

    Submission and Grading Information

    Grading Criteria

    To access your rubric:

    Week 9 Discussion Rubric

     

    Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

    To Participate in this Discussion:

    Week 9 Discussion

     

    What’s Coming Up in Module 8?

    Photo Credit: Getty Images/iStockphoto

    In the next module, 
    you will examine prescribing drugs and the off-label use of drugs to treat pediatric patients. You will also complete your Final Exam.

    Looking Ahead: Final Exam

    Please review the Resources and content in the previous modules in preparation for your Final Exam in Module 8.

     

    NURS 6521 Week 10: Infections and Hematologic Systems

  • Assignment 1: Practicum – Client Termination Summary

    Assignment 1: Practicum – Client Termination Summary

    Students will:

    Develop client termination summaries

    To prepare:

    For guidance on writing a client termination summary, review pages 693–712 of Wheeler (2014) in this week’s Learning Resources.

    Identify a client who may be ready to terminate therapy. With the client you selected in mind, address in a client termination summary (without violating HIPAA regulations) the following:

    ORDER A PLAGIARISM-FREE PAPER HERE

    The Assignment

    Identifying information of client (e.g., hypothetical name and age)

    Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will end

    Total number of sessions, including number of missed sessions

    Assignment 1: Practicum – Client Termination Summary

    Whether termination was planned or unplanned

    Presenting problem

    Major psychosocial issues

    Types of services rendered (e.g., individual, couple/family therapy, group therapy)

    Overview of treatment process

    Goal status (goals met, partially met, unmet)

    Treatment limitations (if any)

    Remaining difficulties and/or concerns

    Assignment 1: Practicum – Client Termination Summary

    Recommendations

    Follow-up plan (if indicated)

    Instructions for future contact

    Signatures

    Required Readings

    Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

    Chapter 17, “Psychotherapy with Children” (pp. 597–624)

    Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712)

    Please avoid plagiarism, the school Is very strict with this issue. Thank you

    The client

    Assignment 1: Practicum – Client Termination Summary

  • NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

    NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

    Week 9: Women’s and Men’s Health

    As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.

    BUY A PLAGIARISM-FREE PAPER HERE

    This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems. NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders.

    Learning Objectives

    Students will:

    Evaluate patients for treatment of complex health issues

    Evaluate patients for treatment of infections

    Evaluate patients for treatment of hematologic disorders

    Analyze patient education strategies for the management and treatment of complex comorbidities

    Learning Resources

    Required Readings (click to expand/reduce)

     

    Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

    As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

    For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes. NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders.

    Photo Credit: Getty Images

    To Prepare

    Review the Resources for this module and reflect on the different health needs and body systems presented.

    Review the complex case asisgned by your Instructor for this Discussion.

    Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected. NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders.

    By Day 3 of Week 9

    Post
     a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

    You will respond to your colleagues’ posts in Week 10.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on
    Submit!

    Submission and Grading Information

    Grading Criteria

    To access your rubric:

    Week 9 Discussion Rubric

     

    Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

    To Participate in this Discussion:

    Week 9 Discussion

     

    What’s Coming Up in Week 10?

    Photo Credit: Getty Images/iStockphoto

    Next week, 
    you will continue working on your Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.

    Next Week NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

  • HCA 340 Cultural Diversity in Health & Illness Essay

    HCA 340 Cultural Diversity in Health & Illness Essay

    Overview

    Prepare a 4–5-page review of recent research that examines statistics on the primary health concern of a population, describes the methods and tools used in the research studies, explains the factors that affect health promotion and disease prevention for a population, and recommends a health care initiative.

    Note
    : The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

    The ability to locate, evaluate, and apply research is an important skill for nurses to develop in order to provide evidence-based care for individuals, families, communities, and health care systems. HCA 340 Cultural Diversity in Health & Illness Essay.

    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

    ORDER A PLAGIARISM-FREE PAPER HERE

    · Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations.

    . Compare the statistics for a health concern of a vulnerable or diverse population to the statistics for the general population, including ethical, legal, economic, and cultural factors.

    . Explain the principles and concepts that influence health promotion and disease prevention for the identified vulnerable or diverse population.

    . Recommend an evidence-based health care initiative for a specific health care concern of a vulnerable or diverse population.

    · Competency 3: Apply basic epidemiological concepts, data analysis methods, tools, and databases to determine the effectiveness of health promotion and disease prevention initiatives for diverse and vulnerable populations.

    . Describe the epidemiological concepts, data analysis methods, tools, and databases used in research studies related to health concerns for a vulnerable or diverse population.

    . Describe health care initiatives used by organizations to address the health care concerns of vulnerable or diverse populations.

    · Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions.

    . Write content clearly and logically, with correct use of grammar, punctuation, APA formatting, and mechanics.

    Assessment Instructions

    Preparation

    Your team has presented its preliminary findings to the executive leadership in your organization, but leadership has some doubts about some of the information they received. Each member of the team has been charged with doing a critical examination of recent research around each member’s area of expertise. As the team’s nursing representative, you need to look specifically at the health care concerns identified in the Windshield Survey assessment. HCA 340 Cultural Diversity in Health & Illness Essay.

    The first step in preparing to write a review of the research is to define your topic. For this assessment, your review will provide a comprehensive overview of the needs of the population you identified in the Windshield Survey assessment in terms of health promotion and disease prevention, the factors that contribute to health disparities for the population, and the need for the organization to improve health care delivery to the population.

    In the Capella library, search for current scholarly or peer-reviewed professional research articles that:

    · Examine the health care risks and needs of your population.

    · Analyze the need to improve health care delivery to the population.

    · Evaluate, critically, the factors that affect health promotion and disease prevention for the population.

    · Examine strategies to reduce health disparities for your population.

    Locate at least 5–7 resources so that you can eliminate 2–3 if necessary. You may discover, for example, as you read each article more in-depth, that they may not all have the focus you need for your review.

    Requirements

    For this assessment, you need to develop several points around which to apply the research from the articles you located. Specifically, you need to:

    · Compare statistics for the primary health concern of your population to the rest of the general population in the United States. This would include frequency of occurrence, age groups most at risk, frequency of fatality, and so on.

    · Describe the epidemiological concepts, data analysis methods, tools, and databases used in the research studies you located. Address any flaws or biases you believe are present.

    · Explain the factors that affect health promotion and disease prevention for the population. (Hint: These may be things such as language barriers, cultural values, generational differences, social fear, and access to services.)

    · Describe the types of health care initiatives that have been tried by other organizations specifically for the primary health care concern or the population.

    · Recommend one health care initiative for your population, based on your research,

    These should be the ideas, or points, that your review is based on. For each point, present all of the evidence you located. For this assessment, that should be at least four current research articles, although not all of the articles will typically offer evidence on all of your points. HCA 340 Cultural Diversity in Health & Illness Essay.

    Be sure your assessment includes:

    · An introduction that presents the points you will cover.

    · The body that presents the research on the points.

    · A conclusion that restates the points in your introduction.

    Your assessment should be 4–5 pages in length, not including the title page and reference page. Be sure you follow APA guidelines for style and format.

    Additional Requirements

    · Include a title page and reference page. The completed assessment should be 4–5 pages in length, not including the title page and reference page.

    · Reference at least four current scholarly or professional resources.

    · Use current APA format.

    · Use Times New Roman font, 12 point.

    · Double-space.

     

    Multiple Choice Questions (Enter your answers on the enclosed answer sheet)

    1. A patient from the Mexican heritage relates using a curandero for health care needs. What are the characteristics of this type of healer?

    a. Considered to be a religious figure

    b. Was born as a healer

    c. Taught the ways of healing through herbs

    d. All of the above.

    2. In the Mexican health care system, what is the scope of practice of the partera?

    a. The care given is confined to the pregnant woman

    b. Only provides physical care

    c. Acts alone without doing other consultations or referrals

    d. Does not participate in labor and delivery

    3. During a medical history with a patient from Puerto Rico, what preparations will the nurse need to include?

    a. Those obtained from a botanica

    b. Those obtained from a botanical center

    c. Those obtained from a healer

    d. Those obtained from a pharmacy

    4. Which is a dilemma encountered by health care providers when trying to accommodate a patient of the Mexican culture’s desire to maintain hot and cold food preferences? HCA 340 Cultural Diversity in Health & Illness Essay.

    a. Avoiding all foods that contain certain spices

    b. Understanding which foods the patient considers hot and cold

    c. Obtaining the unusual foods native to a Mexican patient’s diet

    d. Ensuring that all medications are taken with specific foods

    5. Where might a patient of Puerto Rican heritage seek help when experiencing signs of a mental illness?

    a. Milagros

    b. Curanderismo

    c. Santeria

    d. Partera

    6. What is a significant factor when caring for health problems of patients within the Hispanic culture?

    a. Lack of Spanish-speaking health care providers impeding appropriate care delivery

    b. Failure to highlight common chronic diseases among Hispanics in local media

    c. Overall population is elderly

    d. Use of folk remedies creating cultural dissonance with the medical establishment

    7. What would the combination of a young population, high birthrates, and lower socioeconomic status contribute to in the Hispanic population?

    a. Higher incidence of births to women under age 18

    b. Lower birth weight infants

    c. Higher percentage of first trimester prenatal care

    d. Higher infant mortality rate

    8. Which health problem does the nurse identify as being a higher risk for the patient from the Hispanic culture when compared to the general population?

    a. Septicemia

    b. Unintentional injuries

    c. Chronic lower respiratory diseases

    d. Alzheimer’s disease

    9. What would the nurse infer about the incidence of lung cancer being lower among Hispanic women versus that of the general population?

    a. Hispanic women are not genetically predisposed to lung cancer.

    b. Hispanic women are healthier than the general population.

    c. Hispanic women have better preventive health practices.

    d. Hispanic women are less likely to smoke.

    10. What might a patient of German descent used to treat a stomachache?

    a. Drink peppermint tea

    b. Stop eating for at least 24 hours

    c. Take black draught

    d. Eat chicken soup

    11. Which actions might a patient of German descent use to treat a cough?

    a. Rub goose fat on the chest

    b. Eating honey and milk

    c. Drinking rum

    d. All of the above.

    12. When caring for a postoperative wound at home, what would a patient of German descent tend to use?

    a. Kerosene

    b. Iodine

    c. Salves and liniments

    d. Onion compresses

    13. For what would a patient of German descent use cloves?

    a. Headache

    b. Rheumatism

    c. Toothache

    d. Fever

    14. What would a patient of Italian descent tell the nurse is the cause of pneumonia?

    a. Moving air in the form of drafts

    b. Eating food that was not nutritious

    c. Improper balance of fluids

    d. Not dressing properly

    15. What will the nurse assess as an important component of healing for a patient of Italian descent?

    a. Religious faith in God

    b. Use of garlic and olive oil in tonics

    c. Wearing black when a family member is ill

    d. Eating pasta at every meal

    16. What will a patient of Polish descent tell the nurse is used to treat a cough? HCA 340 Cultural Diversity in Health & Illness Essay.

    a. Taking garlic oil

    b. Goose grease rubbed on the throat

    c. Drinking hot lemonade with whiskey

    d. A tomato plaster on the chest

    17. What will a patient of Polish descent use to treat a burn?

    a. Aloe vera

    b. Salt pork

    c. Carbolic salve

    d. Turpentine and liniment

    18. For what would a patient of Polish descent tell the nurse that paregoric is used?

    a. Gas

    b. Diarrhea

    c. Indigestion

    d. Cramps

    19. In which ways does the current United States health care system create barriers to individuals from different cultures? HCA 340 Cultural Diversity in Health & Illness Essay.

    a. Expectation to select a physician from a list

    b. Cost of treatments and tests

    c. Violation of cultural beliefs and practices

    d. All of the above.

    20. How would the use of patient advocates bridge the gap of inadequate numbers of health care providers representing culturally diverse population groups?

    a. Speak to patients in their native language

    b. Coordinate services to meet the patients’ needs

    c. Resolve problems

    d. All of the above.

    21. The health care administrator is identifying ways to improve communication with non-English speaking patients. Which languages would the administrator target as being spoken by hospital employees?

    a. Russian

    b. Chinese

    c. Spanish

    d. None of the above.

    22. The nurse is experiencing collisions when attempting to improve cultural competency. What types of collisions is this nurse experiencing?

    a. Meeting dense cultural barriers

    b. Sabotaged efforts

    c. Unexpected hills

    d. a and b only

    23. Two nurses are overhead talking about their experiences with cultural competency. Which experience would be considered an unexpected positive event?

    a. Deep love of life and people

    b. Role of a healer within a culture

    c. Learning a foreign language

    d. Being an advocate for funding

    24. What self-observation does the nurse make that indicates that the nurse is “on the road” to cultural competency?

    a. you should only observe your own health and illness beliefs

    b. Individual culture and religion

    c. Adhering to ways to protect health that are consistent with the dominant culture

    d. Avoiding the use of amulets

    25. What action would a nurse take to learn more about the different cultures represented in the community?

    a. Walk through the community

    b. Prepare a guide sheet with a list of herbs

    c. Recognize hot–cold imbalances

    d. Recognize folk diseases

     

    Diverse Population Care

    Diverse Population Care

    uDiverse Population Care

    uThe Amish

    uThe Inuit

    u
    Two different cultures

    The Amish

    Founded by Jacob Amman (1644-1720) in Europe.

    Originally from Switzerland and south Rhine river region until 18th century migration to USA.

    Most settled in Pennsylvania.

    Isolated from modern society.

    Speak English and Pennsylvania German (“Dutch”).

    What is “culture”?  Culture is the customary beliefs, social forms, and material traits of a racial, religious, or social group.

    Today we are going to discuss two different cultures.

    The Amish

    The Amish society originated in Europe established by Jacob Amman (1644 to 1720) (Robinson, 2012).  Originally, they were part of the Mennonites but separated from the Mennonites because the felt there was a lack of discipline within the Mennonites.  They lived in Switzerland and the southern Rhine river region until the 18th century and then migrated to the United States of America (USA), where they settled in Pennsylvania, New York, Illinois, Indiana, Iowa, Missouri, Ohio, and some other states.  They try to preserve their origin culture which is based on the late 17th century European rural culture by avoiding modern society and developing practices and behaviors that will keep them isolated from modern society.  The Amish speak the language of German known as Pennsylvania German, or Pennsylvania Dutch (Amish America, 2010).  There are some comparisons with languages of German spoken in Europe today, though Pennsylvania German consists of many English words.  Accents and mannerisms of speaking Pennsylvania Dutch often varies between individual Amish communities.  Also, there is no written version of this language.

    The Inuit

    The two main groups of Eskimos are the Inuit of northern Alaska, Canada, and Greenland, and the Yupik of central Alaska.  In most places, the term Eskimo has become a derogatory term (aaanativearts).  The term Eskimo has been replaced with the preferred term Inuit.  The Inuit are indigenous to Alaska but have traditionally inhabited the area around the pole covering eastern Siberia (Russia), Alaska (United States), Canada, and Greenland.  Their evolution is defined as having four phases related to the well-defined differences in their technologies used for hunting and tool making.   The earliest known Inuit date back 5,000 years ago in Alaska from people who used Artic small tool traditions.  It is possible that they migrated to Alaska from Siberia 2,000-3,000 years earlier, but the history is difficult to determine due to lack commonalities in their languages.   The Inuit language has two major divisions:  Yupik, spoken in Siberia and southwestern Alaska and Inuit, spoken in northern Alaska, Canada, and Greenland (Babbi & Jackson, 2003).  There are different names for the language in some of the regions.  Across the North Pole, there are two styles of Inuit written language.  One form uses Roman alphabet and the other uses symbols to represent sounds.  Both forms were generated by missionaries.  The form that was used depended on which missionary was where, hence the lack of commonality in communication.  The Roman alphabet is used to write Inuktitut in Alaska.  According to Babbi & Jackson (2003), Inuktitut translates as “in the way of the Inuk” (Inuk is the singular form of Inuit).

    uCultural health practices of the Amish

    uCultural health practices of the

    uAMISH health disorders

    Rare conditions

    Ellis-van Creveld syndrome – dwarfism and polydactylism

    Glutaric aciduria – unable to process amino acids causing build up in the blood and urine

    Crigler-Najjar syndrome – hyperbilirubinemia causing jaundice and brain damage

    Maple Syrup Urine disease – due to inability to process some amino acids properly – causes seizures, coma, and death in untreated infants

    u

    uINUIT health disorders

    Common Conditions

    Coronary artery disease – high mortality due to cerebrovascular strokes

    Osteoporosis

    Parasitic transmission

    Environmental pollutants

    u

    Adult Health Practices including care of the elderly and perspective on death

    Amish health care practices vary across the communities and from family to family (Amish Studies).  Although they recognize God as the ultimate healer, they do not cite any Biblical reason to oppose traditional healthcare.  They do prefer alternative treatments, based in homeopathic remedy.  They are not likely to seek medical care for minor aches or illnesses.  The prefer folk remedies and are not likely to employ heroic measures to save a life, as they would choose instead to allow nature to take its course.  They often feel awkward around advanced technology and find that most providers are not sensitive to their cultural preferences.  They may face long journeys to reach medical facilities, especially since they travel by horse and buggy.  Furthermore, since education generally stops at the eighth-grade level, they may not understand what providers are trying to tell them.

    Labor & Delivery

    Childbirth for the Amish woman is a serious life event (Wickwire, 2006).  All Amish women are believed to be at high risk for problems during their childbearing period . The Amish do not practice birth control and therefore have large families with closely spaced pregnancies.  Also, due to the lack of birth control, the maternal age for pregnancy may be advanced.  Stress of worry about adding financial burden to the family also contributes to the high risk of complications, as they are less likely to seek early prenatal care.  There is also the mistrust of traditional healthcare, fear of lack of cultural sensitivity, and the inconvenience of traveling long distances to seek services which contributes to high risk for complications.

    However, Amish will often select which service best meets their individual and cultural needs.  Most deliveries are attended in their own homes by Amish lay midwives and occasionally physicians who provide home care.  Some communities have birth centers within them, with midwives who provide prenatal visits, Lamaze classes, and accommodate the use of herbs and complementary therapies.

    Pediatrics

    The Amish usually keep excellent historical and genealogical records (Vockley, 2019).  Given that the communities are known for their self-isolation and little to no migration within the group, it is not uncommon to a loss of genetic variation that would normally result from merging with larger populations.  Inbreeding directly results in genetic mutations, also known as the founder effect.  Because the Amish typically have larger families, there is usually a significant number of children which provides adequate numbers of affected and unaffected siblings within a sibship.  This allows for the study of the genetic mutations.

    The most common gene mutations cause mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS);  developmental delay, short stature, hypotonia, hearing loss, renal failure, migraines, fatigability, and poor appetite are also common.  Recurrent miscarriages are also attributable to these gene mutations.  Children as young as 12 years old are reported to have acute strokes with progressive dysphagia, weakness, and respiratory failure, unto death (Vockey, 2019).

    Although some communities will participate in childhood vaccinations, parents are usually selective about what vaccines their children will and will not receive, if any at all.  Amish prefer the order of natural selection and prefer natural exposure over vaccination.

     

    The Inuit, have accepted that “times change” and favor modern amenities.

    Adults

    According to the National Earth Science Teachers Association (NESTA), The Inuit communities were most commonly found in the tundra where not many building materials exist.  In the winter, the Inuit lived in igloos and in the summer, they lived in huts made from animal skins.  Migration between communities was essential for survival.  In modern times, materials are often imported, and the Inuit live in houses.  Hunting and fishing were common as there was no where to grow a garden on the frozen tundra, thus, meals consisted mainly of meats.  Clothing was commonly made from animal skins, including boots and coats.  Following the end of World War II, military bases and permanent communities were established.  As these areas grew, schools and health care centers were created which brought non-native traditions.  Through improved health care, the Inuit population grew and many moved to permanent settlements so that they could have access to jobs and foods.

    Aging/ Elderly

    The Inuit recognize that age is found in numbers but do not decide that they are “old” based on that number.  Most Inuit continue to work, hunt, gather, fish, etc., until they are too tired to do so.  According to the Inuvialuit Regional Corporation (Collings, 2000), Inuit reaching the age of 50 begin to receive installment payments resulting from the land claims settlement.  Therefore, elderly has been defined as the age of 50 years.  In modern times, however, health care and economy has improved and become more available.  Inuit are living longer.  As they get older, they are more respected for their experiential wisdom.  They are expected to pass on their knowledge to younger generations.  They receive the same medical care as non-Inuit.  The Inuit have long been reported to send their elderly out into the tundra to die, however this was only done during times of great famine and is not a customary process.

    Labor & Delivery

    According to Ketchum (2019), traditional Inuit customs expect women to endure labor without making noise and without taking pain medications, while standing upright.  These traditions have relaxed and in modern Inuit societies, many women birth their children in the hospital setting.  Oder traditions dictate the birth of the child through a midwife, in a birthing hut.  The midwife is required to “make the baby” by touching its genitals as soon as they are exposed, thereby preventing the baby from changing its sex at the last minute.

    Pediatrics

    Beliefs that “baby teeth” aren’t important, lack of fluoride, and cost of accessing early dental care causes the high incidence of dental caries and oral infections in Inuit pediatrics (American Academy of Pediatrics, 2011).  Infections that may begin as oral infections can also lead to respiratory or ear infections.

     

    Amish Health Disorders

    The Amish have some diseases that are rarely seen in other populations.

    Ellis-van Creveld syndrome is an inherited disorder that affects bone growth and results in a short stature (dwarfism), extra fingers or toes, malformed fingernails or toenails, and some dental abnormalities (DHH, 2019).  Most also have a heart defect which could be life-threatening.

    Glutaric Aciduria s a rare but very serious genetic condition that causes the body to be unable to process certain amino acids.  This, in turn, causes a harmful build-up of poisons in the blood and urine (NHS, 2018).

    Crigler-Najjar syndrome (DHH, 2019) is a very severe hereditary condition characterized by hyperbilirubinemia.  Unconjugated bilirubin needs to be converted to a nontoxic form called conjugated bilirubin. In those with Crigler-Najjar syndrome there is a buildup of unconjugated bilirubin causing jaundice. Severe unconjugated hyperbilirubinemia can lead to a condition called kernicterus, which is a form of brain damage.  Brain damage caused by the accumulation of unconjugated bilirubin in the brain and nerve tissues causes lethargy, muscle weakness, and hypotonia.  Other neurological, including involuntary writhing movements of the body (choreoathetosis), hearing problems, or intellectual disability can also occur.

    Maple syrup urine disease (NHS, 2018) is an inherited disorder in which the body is unable to process certain protein amino acids properly. This disease earned its name because of the distinctive sweet odor of affected infants’ urine.  It is often characterized by poor feeding, vomiting, lack of energy (lethargy), abnormal movements, and delayed development.  If untreated, maple syrup urine disease can lead to seizures, coma, and death

    Some illnesses are so uncommon that they are unique to these communities (such as Troyer Syndrome or Amish lethal microcephaly), or rarely seen elsewhere. Some groups of Amish may exhibit diseases more likely to be seen in the general public, but at a higher rate.  These include cystic fibrosis, muscular dystrophy and deafness in some communities.

     

    Inuit Health Disorders

    According to Dr. McDougal (2015), the diet of the Inuit was limited due to geographical location.  Therefore the Inuit ate diets largely comprised of raw meats.  After finding and autopsying remains of ancient Inuit and evaluating modern day Inuit, it is noted the most common reason for mortality in this culture is extensive hardening of the arteries.  Coronary artery disease has led to cerebrovascular stroke, and death.  Mummified remains of two Inuit women of different ages also showed severe Osteoporosis.  This is partly due to a diet low in calcium, but also related to lack of sunlight.  The typical Inuit diet was high in protein, high in nitrogen, high in phosphorus, and low in calcium.

    Other concerns are related to the transmission of parasites from raw meats to humans.  Dr. McDougal (2015) cites one example as trichinosis, associated with the roundworm Trichinella spiralis.  He reports that this parasite can be found in approximately 12% of older Inuit.

    And finally, eating raw and infected animal meat can not only cause infestation from parasites but also expose the Inuit to high concentrations of environmental chemicals.  Dr. McDougal (2015) cites the Inuit as having the highest human concentrations of environmental chemicals than any other human population on earth.

    Tips for working with the Amish patient

    According to Waltman (2005), there are many ways to approach Amish patients in a culturally sensitive manner.

    1.It is important to know which group the Amish patient belongs to.  Knowing how conservative or liberal the group is will help in the decision-making for cares and services.

    2.Amish culture is one where value is placed on face to face communications.  The Amish patient may ask personal questions, in an effort to individualize their care giver.  It’s important to answer honestly and be as open as possible.

    3.Probably the most important issue is to accept Amish values, beliefs, customs, and attitudes, even if they are different from your own.

    4.If possible, consider modifying the delivery of the care service to accommodate Amish preferences and overcome the barriers of distance, transportation, and cost.  One example might be to place a hitching post for the horse outside of the facility.

    5.Just as holidays may be important to you, Amish also recognize holidays.  For example, Sundays are a day of rest.  It is important to be aware of Amish holidays since their belief in God will have priority over all medical requirements.

    6.Talking with Amish patients is no different than talking to any other patient.  Talking about the weather or current events is often appreciated.  No patient should ever be spoken to in a condescending manner, even an Amish patient.  Though it is important to talk slowly and allow time for discussion of issues.

    Tips for working with the Inuit patient

    Flowers, (2005), determined that It is never wise for any health care provider to stereotype their patient.  Cultural issues such as spirituality, language, and healthcare, as well as racial characteristics such as skin color, vary greatly among individuals, especially among Inuit tribes and in families within tribes.  Inuit of certain tribes or families may have specific spiritual or healing rituals or ceremonies that they feel necessary to conduct, even within healthcare facilities.  It is critical to be in tune to those needs for spirituality.  Most Inuit have large families, by blood or not.  Nieces, nephews, uncles, and so on, may want to visit.  Communication is most important and helpful for providers who wish to make the relationship satisfying for patients as well as providers, keeping in mind that communication is not only what is said in words, but also in body language.  Lastly, respect is vital.  Even if the care provider does not believe as the Inuit do, it is important to respect their customs and beliefs. HCA 340 Cultural Diversity in Health & Illness Essay

    uTips for working with the Amish patient

    uConservative or Liberal community

    u

    uFace to face honesty

    u

    uAccept Amish values, beliefs, customs, and attitudes, even if they are different from your own.

    u
    Service modification

    u

    u
    Amish holidays

    u

    u
    Socialization and communication

    uTips for working with the Inuit patient

    uDon’t stereotype

    u

    uAllow spirituality needs

    u

    uExtended families

    u

    uCommunication

    u

    uRespect

    uReferences

    Robinson, B.A.  (2012, August 24).  The Amish: history, beliefs, practices, conflicts, etc. 
    Ontario consultants on religious tolerance. 
    Retrieved from:  http://www.religioustoler HCA 340 Cultural Diversity in Health & Illness Essay

    ance.org/amish.htm

    Dr. McDougall.  (2015).  Extreme nutrition:  The diet of the Eskimos. 
    Dr. McDougall’s Health & Medical Center
    .  Retrieved from https://www.drmcdougall.com/misc/2015nl/apr/eskimos.htm

    Amish America.  (2010).  What language do the Amish speak? 
    Exploring Amish culture and communities
    .  Retrieved from:  Amishamerica.com/what-language-do-the-amish-speak/#footer_stallion

    American Academy of Pediatrics.  (2011).  Early childhood caries in indigenous communities. 
    Pediatrics, 127
    (6).  Retrieved from:  https://pediatrics.aappublications.org/content/127/6/1190

    uReferences

    Aaanativearts.  (n.d.).  Eskimo culture. 
    AAA Native Arts
    .  Retrieved from:  https://www.aaanativearts.com/eskimo-culture

    Fabbi, N. & Jackson, H.M.  (2003, March).  Inuktitut – the Inuit language. 
    K12studycanda,
    pp 1-7.  Retrieved from:  http://www.k12studycanada.org/files/Inuktitut.pdf

    Amish Studies.  (2019).  Health. 
    Amish studies: The Young Center, cultural practices. 
    Retrieved from:  https://groups.etown.edu/amishstudies/cultural-practices/health/

    Wickwire, V.L.  (2006, January).  Amish childbearing beliefs and practices and the implications for nurse-midwives as servant-leader care providers. 
    Dissertation, 1542. 
    Retrieved from:  https://digitalcommons.andrews.edu/cgi/viewcontent.cgi?article=2541&=&context=dissertations&=&sei-redir=1&referer=https%253A%252F%252Fwww.bing.com%252Fsearch%253Fq%253Dbirthing%252Bamong%252Bthe%252Bamish%2526FORM%253DHDRSC1#search=%22birthing%20among%20amish%22 HCA 340 Cultural Diversity in Health & Illness Essay

    uReferences

    Vockley, G.  (2019).  Genetic disease in Amish
    .  UPMC Children’s Hospital  of Pittsburgh
    .  Retrieved from:  http://www.chp.edu/research/areas/genetics/projects/vockley/amish

    Amish America.  (2010).  Do Amish have genetic disorders? 
    Exploring Amish culture and communities
    .  Retrieved from:  http://amishamerica.com/do-amish-have-genetic-disorders/

    U.S. Department of Health & Human Services (DHH).  (2019).  Ellis-van Creveld Syndrome. 
    GU.S. National Library of Medicine. 
    Retrieved from: 
    https://ghr.nlm.nih.gov/condition/ellis-van-creveld-syndrome

    NHS (2018).  Glutaric aciduria type 1.  Retrieved from
    https://www.nhs.uk/conditions/glutaric-aciduria/#

    Waltman, G.H. (2005).  Guidelines for professionals when working with the Amish community. 
    The Pennsylvania child welfare training program. 
    Handout #15, pp. 1-2.  Retrieved from:  http://www.pacwrc.pitt.edu/Curriculum/522SprvsryIsssInChldSxlAbs/Hndts/HO15GdlnsFrPrfssnlsWhnWrkngWthThAmshCmmnty.pdf

    uReferences

    Ketchum, D.   (2019, September).  Inuit pregnancy & conception beliefs. 
    Classroom synonym
    .  Retrieved from:  https://classroom.synonym.com/inuit-pregnancy-conception-beliefs-11481.html

    Collings, P.  (2000).  Aging and life course development in an Inuit community. 
     Artic Anthropology, 37
    (2), pp. 111-125.  Retrieved from :  https://www.lakeheadu.ca/sites/default/files/uploads/53/outlines/2014-15/GEOG3671/Project/CollingsAgingandLifeCourseDevelopment2000.pdf

    National Earth Science Teachers Association.  (2019).  Inuit culture, traditions, and history. 
    Windows to the universe. 
    Retrieved from:  https://www.windows2universe.org/earth/polar/inuit_culture.html

    Flowers, D.L. (2005).  Culturally competent care for American Indian clients in a critical care setting. 
    Critical Care Nurse, 25
    , pp. 45-50.  Retrieved from:  http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.525.6221&rep=rep1&type=pdf HCA 340 Cultural Diversity in Health & Illness Essay

    u

  • Assignment: Off-Label Drug Use in Pediatrics

    Assignment: Off-Label Drug Use in Pediatrics

    Week 11: Pediatrics

    Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

    This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.

    Learning Objectives

    ORDER A PLAGIARISM-FREE PAPER HERE

    Students will:

    Evaluate the practice of prescribing off-label drugs to children

    Analyze strategies to make the off-label use of drugs safer for children

    Assignment: Off-Label Drug Use in Pediatrics

    Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

    Learning Resources

    Required Readings (click to expand/reduce)

     

    Rosenthal, L. D., & Burchum, J. R. (2018).
    Lehne’s pharmacotherapeutics for advanced practice providers
    . St. Louis, MO: Elsevier.

    Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67)

    Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives.
    The Journal of Pediatric Pharmacology and Therapeutics
    ,
    20
    (4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/

     

    This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.

     

    Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children.
    The Journal of Pediatric Pharmacology and Therapeutics
    ,
    22
    (6), 423–429. doi:10.5863/1551-6776-22.6.423

    Note:
    You will access this article from the Walden Library databases.

     

    This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.

     

    Required Media (click to expand/reduce)

     

    Laureate Education (Producer). (2019i).
    Therapy for pediatric clients with mood disorders
    [Interactive media file]. Baltimore, MD: Author.

     

    Assignment: Off-Label Drug Use in Pediatrics

    The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

    When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Assignment: Off-Label Drug Use in Pediatrics

    Photo Credit: Getty Images

    Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

    To Prepare

    Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.

    Reflect on situations in which children should be prescribed drugs for off-label use.

    Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics. Assignment: Off-Label Drug Use in Pediatrics

    By Day 5 of Week 11

    Write
    a 1-page narrative in APA format that addresses the following:

    Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

    Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

    Reminder:
    The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at
    http://writingcenter.waldenu.edu/57.htm
    ). All papers submitted must use this formatting.

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

     

    Decision Point One

     

    Begin Zoloft 25 mg orally daily

    RESULTS OF DECISION POINT ONE

    Client returns to clinic in four weeks

    No change in depressive symptoms at all

    Decision Point Two

     

    Increase dose to 37.5 mg orally daily

     

    RESULTS OF DECISION POINT TWO

    Client returns to clinic in four weeks

    Depressive symptoms decrease by 20%. Client reports feeling a little bit better

    Decision Point Three

     

    Maintain current dose

     

    Guidance to Student

    At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate. Assignment: Off-Label Drug Use in Pediatrics.

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

     

    Decision Point One

     

    Begin Paxil 10 mg orally daily

    RESULTS OF DECISION POINT ONE

    Client returns to clinic in four weeks

    Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea

    Decision Point Two

     

    Decrease dose for 7 days then return to previous 10 mg day dose

     

    RESULTS OF DECISION POINT TWO

    Client returns to clinic in four weeks

    Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose

    Decision Point Three

     

    Attempt to decrease dose for another 7 days then return to 10 mg dose

     

    Guidance to Student

    Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects. Assignment: Off-Label Drug Use in Pediatrics.

     

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

     

    BACKGROUND INFORMATION

    The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

    Client complained of feeling “sad”

    Mother reports that teacher said child is withdrawn from peers in class

    Mother notes decreased appetite and occasional periods of irritation

    Client reached all developmental landmarks at appropriate ages

    Physical exam unremarkable

    Laboratory studies WNL

    Child referred to psychiatry for evaluation

     

    MENTAL STATUS EXAM

    Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

    You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

     

    RESOURCES

    Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

     

    Decision Point One

    Select what you should do:

    Begin Zoloft 25 mg orally daily

    Begin Paxil 10 mg orally daily

    Begin Wellbutrin 75 mg orally BID

     

     

     

     

     

     

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

     

    Decision Point One

     

    Begin Paxil 10 mg orally daily

    RESULTS OF DECISION POINT ONE

    Client returns to clinic in four weeks

    Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea

    Decision Point Two

     

    Increase dose to 20 mg orally daily

     

    RESULTS OF DECISION POINT TWO

    Client returns to clinic in four weeks

    Nausea, vomiting, and diarrhea has increased and client is refusing to take medication

    Decision Point Three

     

    Discontinue Paxil and begin Prozac 10 mg orally daily

     

    Guidance to Student

    Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all clients.

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

     

    Decision Point One

     

    Begin Wellbutrin 75 mg orally BID

    RESULTS OF DECISION POINT ONE

    Client returns to clinic in four weeks

    Child is unable to fall asleep at night

    Decision Point Two

     

    Change from immediate release to extended release 150 mg orally daily in the morning

     

    RESULTS OF DECISION POINT TWO

    Client returns to clinic in four weeks

    Child’s sleep patterns return to baseline. No change in depressive symptoms

    Decision Point Three

     

    Change to SSRI

     

    Guidance to Student

    You can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.

     

     

    REFERENCE GIVEN IN THE SYUDENT PORTAL

    Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children.
    The Journal of Pediatric Pharmacology and Therapeutics
    ,
    22
    (6), 423–429. doi:10.5863/1551-6776-22.6.423

     

     

    -REFERENCE GIVEN IN THE STUDENT PORTAL

    ———
    NCBI

    Skip to main content

    Skip to navigation

    Resources

    How To

    About NCBI Accesskeys

    PMC

    US National Library of Medicine

    National Institutes of Health

    Top of Form

    Search database

    Bottom of Form

    Search term

    Advanced

    Journal list

    Help

    Journal List

    J Pediatr Pharmacol Ther

    v.20(4); Jul-Aug 2015

    PMC4557722

    J Pediatr Pharmacol Ther
    . 2015 Jul-Aug; 20(4): 316–328.

    doi: 
    10.5863/1551-6776-20.4.316

    PMCID: PMC4557722

    PMID:
    26380572

    Unlicensed and Off-Label Drug Use in Children Before and After Pediatric Governmental Initiatives

    Jennifer Corny
    , PharmD, Candidate,
    1

    Denis Lebel
    , BPharm, MSc,
    1

    Benoit Bailey
    , MD, MSc,
    2
    and
    Jean-François Bussières
    , BPharm, MSc, MBA
    1,3

    Author information

    Copyright and License information

    Disclaimer

    This article has been
    cited by
    other articles in PMC.

    Go to:

    Abstract

    OBJECTIVES:
    Governmental agencies (US Food and Drug Administration and European Medicines Agency) implemented initiatives to improve pediatric clinical research, starting in 1997 and 2007, respectively. The aim of this review was to quantify the unlicensed and off-label drug uses in children before and after these implementations.

    METHODS:
    Literature review of unlicensed and off-label drug uses was performed on PubMed and Google-Scholar from 1985 to 2014. Relevant titles/abstracts were reviewed, and articles were included if evaluating unlicensed/off-label drug uses, with a clear description of health care setting and studied population. Included articles were divided into 3 groups: studies conducted in United States (before/after 2007), in Europe (before/after 2007), and in other countries.

    RESULTS:
    Of the 48 articles reviewed, 27 were included. Before implementation of pediatric initiatives, global unlicensed drug use rate in Europe was found to be 0.2% to 36% for inpatients and 0.3% to 16.6% for outpatients. After implementation, it marginally decreased to 11.4% and 1.26% to 6.7%, respectively. Concerning off-label drug use rates, it was found to be 18% to 66% for inpatients and 10.5% to 37.5% for outpatients before the implementation. After implementation, it decreased marginally to 33.2% to 46.5% and to 3.3% to 13.5%, respectively. In other countries, unlicensed and off-label drug use rates were found to be, respectively, 8% to 27.3% and 11% to 47%.

    CONCLUSIONS:
    Governmental initiatives to improve clinical research conducted in children seem to have had a marginal effect to decrease the unlicensed and off-label drug uses prevalence in Europe.

    INDEX TERMS:
    off-label use, pediatrics, review

    Go to:

    INTRODUCTION

    Before a drug can be approved for sale in a given market, governmental authorities in each country have to assess its safety, efficacy, and quality. At the end of this process, pharmaceutical companies are granted market authorization, and the drug gets a license for marketing in the country (e.g., Notice of Compliance in Canada). The drug also has a label (i.e. drug monograph), specifying the details for drug use (e.g., target population, dose, indication, specific use). Assignment: Off-Label Drug Use in Pediatrics.

    Virtually all drugs that get an approval for use in adults should also get an approval for use in children; this is often not the case considering the paucity of clinical research for that population. Therefore, drug monographs are frequently silent about the use of the drug in children. However, in most legislation, clinicians can prescribe to children a drug approved for adult (i.e., an off-label use). In some case, clinicians must also import from another country a drug that has not obtained a license for marketing (i.e., an unlicensed use). Both situations expose clinicians and patients to delays, costs, and risks. In response to these challenges, governmental authorities have established various strategies and regulations to oversee and promote clinical research in children and hopefully to decrease both unlicensed and off-label drug uses.

    In 1997, the US Food and Drug Administration (FDA) adopted the FDA Modernization Act (FDAMA),
    1
    followed in 2002 by the Best Pharmaceuticals for Children Act (BPCA),
    2
    which provided an incentive for drug companies to conduct FDA-requested pediatric studies. In 2003, the FDA also created the Pediatric Research Equity Act (PREA), which requires drug companies to study their products in children under certain circumstances.
    3
    In Europe, the European Medicines Agency (EMA) created the European (EU) Pediatric Regulation, in 2007.
    4
    Its objective was to improve the health of children in Europe by facilitating the development and availability of medicines for that population. In other countries, such as in Canada, the Pediatric Expert Advisory Committee was created in 2009 to provide advice to Health-Canada in the development, licensing, and post-approval monitoring of drugs.
    5

    Our hypothesis was that even though these initiatives were not implemented to decrease unlicensed or off-label drug use rates, they probably would have a favorable consequence on those uses. Ten years after the first regulations, we could expect that the prevalence of unlicensed and off-label prescriptions in children would have decreased. Thus, we reviewed the literature to explore the effect of the regulatory changes.

    The primary objective of this literature review was to determine the effect of governmental initiatives to improve clinical research in children on unlicensed and off-label drug uses in inpatient and outpatient settings in the world. The secondary objective was to determine the unlicensed and off-label drug use rates in countries where no governmental initiatives to improve clinical research in children have been implemented.

    Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children.
    The Journal of Pediatric Pharmacology and Therapeutics
    ,
    22
    (6), 423–429. doi:10.5863/1551-6776-22.6.423 Assignment: Off-Label Drug Use in Pediatrics