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Medicine

Define the term telemedicine Discuss the differences between collaborative care

Define the term telemedicine
Discuss the differences between collaborative care and integrative care.
Discuss the development of telemedicine considerations in children and youths and how you can collaborate with their current pediatric primary care provider.
Consider a situation where you believe the child is in an abusive situation, either with a caregiver outside the home or for an adolescent in an abusive relationship with another older adolescent. What options would you offer to encourage collaborative care between primary care and psychiatric care (you have options of telemedicine and in-office visits)?

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Medicine

Work from the Brown and Goldstein lab provided insights into cholesterol homeost

Work from the Brown and Goldstein lab provided insights into cholesterol homeostasis that were used to develop several of the LDL cholesterol-lowering therapies, including statins that remain in use today. However, in some patients, statins were not as effective as expected, suggestive of additional mechanisms regulating the LDL receptor. After reading CH. 13 and the provided articles, Investigate other LDL cholesterol-lowering therapies (other than PCSK-9 inhibitors), select 1, and compare and contrast the mechanisms of action between the class of drug you select and statins. Include side effects for both types of drugs and information on their efficacy.
RESOURCES:
https://cdn.bc-pf.org/resources/biology/Molecular_biology/Wilson-Molecular_Biology_of_The_Cell_The_Problem_Book_6th_Edition.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC427113/pdf/pnas00137-0094.pdf
2nd article linked as pdf attachment

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Medicine

The combination of doxycycline or fluoroquinolone with metronidazole can also be used in those with a b-lactam allergy.

please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. G.M: Skin and soft-tissue infections (SSTI) can involve one or many layers of skin including the muscle and fascia. Bacterial SSTIs are classified as primary or secondary infections. Human bite wounds are considered secondary infections. SSTIs can also be classified as complicated or uncomplicated; complicated SSTIs can involve surgical intervention. The skin is the primary defense against infections unless it is penetrated among other factors. SSTIs have diverse etiologies. Hand SSTIs are the third frequent type of bites with dog bites being first and cat bites second. Infection in hand SSTIs occurs in 10%-50% of patients. Human bites, especially closed-fist injuries, are more serious than animal bites. The force of a punch can break the metacarpophalangeal joint causing a direct entry for the bacteria to enter in either the joint or bone. The severity of the infection depends on the type of microorganism involved, the patient’s immune status, and the location of injury. Microorganisms seen in human bite wounds include: Eikenella corrodens, S. aureus, streptococci, Corynebacterium spp., Bacteroides spp., and Peptostreptococcus spp. Most hand infections are polymicrobial. The diagnostic criteria of SSTIs are warmth, swelling, erythema, tenderness, pain, dysfunction, and presence of drainage. Severe SSTIs can include systemic symptoms (DiPiro et al., 2020; Ki & Rotstein, 2008).
Most patients do not seek help in a hand SSTI until infection is already present. For a hand SSTI, diagnostic evaluation may include having blood cultures, swab and culture, needle aspiration, x-ray, and an ultrasound. Cultures should be obtained from the infected wound; wounds >24 hours after injury that show no signs of infection do not need to be cultured. Before swabbing, the wound should be cleaned with normal saline or sterile water irrigation. It should be washed with soap or povidone-iodine. Radiologic tests should be performed if bone or joint damage is suspected. Needle aspiration is useful in patients with fluid-filled vesicles. An x-ray is useful in detecting bone involvement and air in the tissues. An ultrasound is useful in detecting crepitus, an abscess, or fascial inflammation. Debridement and exploration may be done depending on the severity of the wound (AAP, 2021). A thorough assessment is needed to prevent loss of function in the hand. The hand should be immobilized depending on the seriousness of the injury. If edema is present, the arm should be elevated until resolved. HIV, hepatitis B and C could be transmitted through a bite, therefore, any information on the biter is useful. Virus-containing blood in the saliva is what can make HIV transmissible; those exposed may be given antiretroviral therapy. A tetanus toxoid and antitoxin may be given as well. Primary closure of a human bite is generally not recommended (AAP, 2021; DiPiro et al., 2020; Ki & Rotstein, 2008). Since a close-fist injury is severe, the patient should be admitted for 2-3 days for close observation (Ki & Rotstein, 2008).
Prophylactic antibiotic treatment is dependent on wound severity and the patient’s immune status, however, those with a hand or face injury are given treatment regardless of status. Prophylactic treatment is generally for 3-5 days. Those with a clenched-fist bite injury are treated differently; they are generally given IV antibiotics. They are given ampicillin-sulbactam or piperacillin-tazobactam. The pediatric dose of piperacillin-tazobactam is 250-350 mg/kg/day IV in three to four divided doses. If the patient is allergic to penicillin, they can be given extended spectrum cephalosporin or trimethoprim-sulfamethoxazole plus clindamycin (AAP, 2021; DiPiro et al., 2020). The combination of doxycycline or fluoroquinolone with metronidazole can also be used in those with a B-lactam allergy. Therapy is usually given for 7-14 days. No improvement seen in 24 hours warrants a debridement. The patient should also be seen by physical therapy to prevent loss of function in the hand (DiPiro et al., 2020).

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Medicine

Clindamycin is a lincosamide that is active against aerobic gram-positive and anaerobic bacteria (hauser, 2019).

please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. S. H. Necrotizing soft tissue infections are clinically characterized by severe and sudden tissue destruction, systemic signs of toxicity, and high mortality (Stevens & Baddour, 2022). Necrotizing fasciitis involves the deep soft tissues leading to “progressive destruction of the muscle fascia and overlying subcutaneous fat” (Stevens & Baddour, 2022, sect. 3). There are two types of necrotizing fasciitis- polymicrobial (type I) and monomicrobial (type II) (Stevens & Baddour, 2022). Type I is typically caused by aerobic and anaerobic bacteria and normally occurs in older adults or in those with comorbidities like diabetes and peripheral vascular disease (Stevens & Baddour, 2022). Type 2 is commonly caused by Group A Streptococci (GAS) and can occur in any individual (Stevens & Baddour, 2022). Prompt diagnosis, immediate antibiotic therapy, and early surgical exploration, in order to confirm necrotizing infection, assess the extent of it, and to debride the tissue, is required (Stevens & Baddour, 2022). The purpose of this discussion is to evaluate pharmaceutical management of a 45-year-old male admitted with an acute presentation of necrotizing fasciitis.
Antibiotic coverage should not be delayed while waiting for cultures to result. Common organisms of necrotizing fasciitis include Streptococci species (gram positive bacteria), Bacteroides (anaerobic gram-negative bacilli), Staphylococcus species (gram-positive bacteria), Clostridium species (anaerobic bacteria), and Enterococcus species (gram-positive bacteria) (Levine, 2020; Hauser, 2019). Although there are a few acceptable regimens, one may include Imipenem 1g IV three times daily, Vancomycin 15 mg/kg IV every six to eight hours, as well as Clindamycin 600 to 900 mg IV every 8 hours (Stevens & Baddour, 2022). Imipenem is a carbapenem that is active against many gram positive, gram negative, and anaerobic bacteria (Hauser, 2019). Vancomycin is a glycopeptide that is active against gram positive organisms (nearly all staphylococci, including methicillin-resistant S. aureus (MRSA) and streptococci, and some enterococci) (Hauser, 2019). Clindamycin is a lincosamide that is active against aerobic gram-positive and anaerobic bacteria (Hauser, 2019). Clindamycin is used especially for its actions on inhibiting toxin production in cases where Group A Streptococcus is suspected (Levine, 2020). This empiric antibiotic treatment plan is comprised of coverage for gram-positive, gram-negative, and anaerobic organisms (Stevens & Baddour, 2022). Adjustments to this regimen can be made once gram stain, culture, and sensitivity results become available.

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Medicine

Peer review comments were:

Proposal is already written but needs improvement in logical flow, scientific reasoning, and methodological accuracy. This is a qualitative study proposal for PhD grant.
Peer review comments were:
The knowledge gap is weak
Aims need to be more open-ended since it is a focused ethnography. Be specific about why focused ethnography is being used (study of culture sharing group). Be more specific, consistent, when presenting rationale or evidence for an statement or argument.

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However, r. s. may prefer to take oral metronidazole, which is also fine.

please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. L.T: 1. List specific goals of treatment for this patient.
Bacterial vaginosis (BV) is caused by a disruption of the normal flora in the vagina, which may result from douching and sexual activity, such as in this case with R. S. (U.S. Department of Health and Human Services, 2021). BV may be asymptomatic, but typical symptoms include white vaginal discharge, fishy odor especially after intercourse, and possibly cervicitis (Sobel & Mitchell, 2022). The vaginal pH may be higher than normal and clue cells can be assessed under a microscope, such as with R.S. (Lin et al., 2021). The normal pH of the vagina is 3.8-5.0 because of the presence of normal flora keeping it acidic, particularly Lactobacilli (Lin et al., 2021). In BV, Lactobacilli is reduced, and other bacteria increase, causing the pH of the vagina to become more alkalotic (Sobel, 2022a). Goals of treatment for R. S. include cessation of her symptoms, as well as prevention of recurrence and STDs.
2. What drug therapy would you prescribe? Why?
The drug therapy I would prescribe for R. S. is metronidazole gel 0.75% vaginal inserts once daily for 5 days (Sobel, 2022b). Vaginal administration treats the infection directly at the source and side effects are less common than with oral administration (Sobel, 2022b). However, R. S. may prefer to take oral metronidazole, which is also fine. In this case, I would instead prescribe her metronidazole 500 mg twice daily for 7 days (Sobel, 2022b). This type of treatment is one I would strongly collaborate with the patient to see which form of administration she prefers, as both are considered equally effective for the treatment of BV.
3. What are the parameters for monitoring the success of the therapy?
Parameters for monitoring success of treatment include cessation of odor and discharge, and absence of recurrence following treatment. More than 50% of women have a recurrent BV infection within the year following initial infection (Morrill et al., 2020). Prevention is aimed at individual risk factors.
4. Discuss specific patient education based on the prescribed therapy.
Specific patient education for this case includes discussion of risk factors for BV and the course of treatment. Douching is associated with a disruption of normal vaginal flora, putting the vagina at risk for infection, including BV and STDs (U.S. Department of Health and Human Services, 2022). Other risk factors for BV include smoking; sexual activity, including oral intercourse; a new sex partner; multiple sex partners; unprotected sex; history of HSV-2 or HIV; women of color; a diet high in fat and low in fiber, folate, vitamin E, and calcium; and being overweight (U.S. Department of Health and Human Services, 2021; Sobel & Mitchell, 2022). These should be discussed in detail with R. S. to prevent future infections. I would educate her on common side effects of metronidazole, including nausea, vomiting, cramping, and metallic taste (Whalen et al., 2019, p. 606). Oral metronidazole should be taken with a full meal to avoid GI upset (Tucker, 2022, p. 267). The evidence for alcohol consumption with metronidazole therapy causing a possible disulfiram-like reaction is lacking, and patients do not need to be advised to stop drinking alcohol during treatment (Sobel, 2022b). R. S. should also be advised to refrain from sexual activity during treatment (U.S. Department of Health and Human Services, 2021).
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
One adverse reaction that would cause me to change therapy is an allergic reaction, albeit rare (Sobel, 2022b). Another reaction that may warrant a change of therapy are severe GI issues (Tucker, 2022, p. 267). If R. S. does not tolerate the side effects of metronidazole, I would prescribe second-line treatment.
6. What would be the choice for second-line therapy? Provide rationale
My second-line treatment choice would be clindamycin 2% vaginal cream once daily for 7 days, which is the second drug of choice for treating BV (Sobel, 2022b). Allergic reactions are more common with this antibiotic than metronidazole, which should be monitored closely especially in those with other allergies (Tucker, 2022, p. 88). Oral clindamycin should be avoided because it may cause c. diff (Sobel, 2022b).
7. What OTC or alternative medications would be appropriate for this patient?
Lactobacilli species probiotics may assist in treating BV with antibiotic therapy and preventing recurrence by reinstituting the vagina’s normal flora (Sobel, 2022b). Another recommendation is the use of boric acid vaginal suppositories in addition to antibiotics, especially in those with recurrent BV, which helps to restore the pH of the vagina (Sobel, 2022b).
8. What dietary or lifestyle changes should be recommended?
Dietary and lifestyle recommendations for R. S. are plentiful. I would advise her to avoid douching and smoking. I would also encourage her to use condoms. I would explain the importance of a balanced diet and maintaining a healthy weight in prevention of recurrence, as well as for other benefits.
9. Describe one or two drug–drug or drug–food interaction for the selected agent.
One drug-drug reaction with metronidazole is with warfarin. Metronidazole may increase the effects of warfarin and thus increase INR and bleeding risk (Sobel, 2022b). There is limited evidence to support that alcohol consumption and metronidazole therapy may produce a disulfiram-like reaction but continues to be a warning on many manufacturer labels (Sobel, 2022b). Therefore, it is important to have an open discussion regarding this topic with patients for them to make their own assessment.

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Medicine

What drug therapy would you prescribe?

please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer: Bacterial Vaginosis Case Study
1. List specific goals of treatment for this patient.
This week the case study is about R.S. is a 32-year-old White woman who seeks treatment for a vaginal discharge that she has had for the past month. This patient states that she is sexually active and has had the same partner for the past 6 months. Her signs and symptoms include an odor, especially after sexual intercourse. Her history reveals that she has been using a commercial douche on a bi-weekly basis during the past year for hygienic purposes in an attempt to prevent vaginal infections. Although the patient denies any other associated symptoms, her vaginal PH is higher than normal at 5.5. the normal vaginal pH is between 3.5 – 5.0 (Jones 2019) The goals of treatment for R.S. include relieving the symptoms such as the vaginal odor and discharge, preventing complications that arise from the condition, and normalizing vaginal pH (Jones, 2019).
2. What drug therapy would you prescribe? Why?
I would prescribe Metronidazole (Flagyl) 750 mg extended-release tablet once daily for seven days or 500 mg twice daily for seven days for treatment of bacterial vaginosis. (Jones 2019) This drug is available in other forms such as an oral pill or cream that can be inserted into the vaginal canal (Woo & Robinson, 2020G). Metronidazole (Flagyl) is an antibiotic that diffuses into bacteria and inhibits protein synthesis by binding onto DNA and causing strand breakage, preventing protein synthesis, and inhibiting growth (Ceruelos, Romero-Quezada, Ledezma & Contreras, 2019). Growth inhibition is key in treating BV, as the condition is caused by the overgrowth of anaerobic bacteria. Therefore, the drug is effective against Gardnerella vaginalis, the organism that is commonly implicated in causing Bacterial Vaginosis (BV) (Jones, 2019).
3. What are the parameters for monitoring the success of the therapy?
The parameters for monitoring the success of the therapy include assessing for the effectiveness by obtaining a sample of the patient’s vaginal secretions to assess for smell and to determine whether these secretions contain clue cells. The absence of clue cells will indicate the success of the treatment (Jones, 2019). Secondly, testing the vaginal pH by placing a pH test strip in the patient’s vagina can indicate the treatment’s success. A pH reading of 4.5 and higher indicates BV, with a reduced value from the baseline value (5.5) indicating the treatment’s success (Jones, 2019).
4. Discuss specific patient education based on the prescribed therapy.
The specific patient education base on Metronidazole therapy will include avoiding any sexual intercourse during therapy to prevent reducing the strength of the medication. Avoid consumption of any alcohol products during the treatment period and encourage patient to wait at least a couple of days after completion of therapy to resume drinking alcohol. I chose the extended-release form for a easy admission as patients tend to for miss doses if they are prescribed multiple times during the day. I would educate R.S to take medication as prescribed, maintain proper vaginal hygiene, continue to monitor for odor and secretion amount, report to the provider if the symptoms have not resolved after seven days.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
Metronidazole is one of the drugs that cause a Disulfiram-like effect (Woo & Robinson, 2020G). Disulfiram is a drug used to treat chronic alcohol addiction by producing sensitivity to ethanol. Therefore, Metronidazole would cause the body to be unable to process the ethanol in alcohol, causing side effects such as abdominal pain, nausea, and vomiting (Ceruelos et al., 2019). The severe side effects that would cause discontinuation of the drug include easy bleeding and bruising, and painful urination.
6. What would be the choice for second-line therapy? Provide rationale?
An appropriate second-line therapy option for the patient’s condition is Clindamycin ovules 100 mg intravaginally once daily at bedtime for three to seven days (Jones 2019). Clindamycin is a bacteriostatic antibiotic that inhibits protein synthesis by binding to the 50S ribosomal subunit (Jones, 2019). The drug is effective in managing anaerobic bacterial overgrowth in BV.
7. What OTC or alternative medications would be appropriate for this patient?
The appropriate OTC alternative medication would be Tinidazole 2 gram once daily for two days or 1 gram once daily for five days. Tinidazole is an antiprotozoal OTC medication that is active against BV. The drug has a longer half-life than Metronidazole, allowing it to be used for a shorter period in treating the condition.
8. What dietary or lifestyle changes should be recommended?
I would advise the patient to avoid the douching she has been doing with the commercial products on a bi-weekly basis. Douching strips, the vaginal canal of essential bacteria that are necessary to maintain a balance between aerobic and anaerobic vaginal bacteria (Jones, 2019). Stripping away these bacteria causes the symptoms that the patient is currently experiencing. Other lifestyle pointers I would provide include wiping from front to back, not using soap to clean the vaginal canal, and using unscented pads and tampons (Jones, 2019).
9. Describe one or two drug–drug or drug–food interaction for the selected agent.
Apart from the reaction with ethanol (alcohol) noted above, Metronidazole also interacts with Omeprazole and other proton pump inhibitors (PPIs). These drugs reduce the acidic concentration of the stomach and are used in managing peptic ulcer disease (Shah & Gossman, 2019). However, Metronidazole requires acidic conditions to facilitate absorption; therefore, these drugs reduce Metronidazole’s absorption (Shah & Gossman, 2019).

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Medicine

-dissemination and update of the guidelines

Hi there… I hope you are doing well
Actually, two presenters will divide and present the topic guidelines on mental health at work. The first part includes an introduction, methods, and the first three recommendations and will be delivered by one of my colleagues.
the second part of the presentation will be mine and includes the following outlines that the writer should cover in the presentation
-Recommendations for individual interventions.
-Recommendations for returning to work after absence associated with mental health conditions.
-Recommendations for gaining employment
for people living with mental health conditions
-Screening programmes
-Research gaps
-Dissemination and update of the guidelines
-What about locally is there any application of these guidelines or any such guidelines in Saudi Arabia
kindly find attached the reference

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To get the approval from the supervisor

Hi I hope you are doing fine
Please I want an essay about the LA and GA in pregnancy
before you start the essay share with me the outlines
to get the approval from the supervisor

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Medicine

I will provide the article we need to do our journal critique, along with the questions we need to answer.

I will provide the article we need to do our journal critique, along with the questions we need to answer.
I don’t know how many pages will take. So I will leave this to the writer’s discretion. The article’s citation should be in APA at the top of the page.