Rethinking Primary Care Delivery

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This is the question :

Rethinking Primary Care Delivery
Quality deficits in the U.S. health care system, along with rising costs, have created pressure on U.S. health care providers to rethink how primary care should be delivered. A variety of innovations are being considered, but one is currently drawing the most attention from both policymakers and health care providers ― the “Patient Centered Medical Home” (PCMH). In fact, various different PCMH models now are being tested in the U.S. Your group, which works for East-West Hospital and Health System, has been asked to prepare a memo for your boss in order to bring him up to date on the PCMH model and its implementation in the United States. He would like you to address the  following.
In your opinion, would the PCMH approach to reorganizing primary care in the U.S., if implemented on a broad scale, improve or worsen the predicted shortage of primary care physicians there? Explain.
Your boss is concerned that your memo covers all of this question that you document your thoughts through the use of appropriate citations to the literature. He wants you to limit your memo to no more than one double-spaced, single-sided pages in size 10 font or larger. The references are not included in the four page limit.

In my opinion, PCMH if implemented on a broad scale in US would improve the predicted shortage of primary care physicians . 
Explanation :
• Use of multi-medical team e.g Social and mental health services, Clinical preventive services or other Specialists can be decrease the shortage of primary care Physicians.
• Use of Nonphysician e.g Nurse Practitioners, and Physician Assistants can be decrease the shortage  of Primary Care Physicians.
• Use of new models of care e.g interactive online tools, and Phone consultation can be decrease the shortage of primary care Physicians.
• This type of innovation PCMH will Increase and Improve the payment system for the Primary Care Physicians which will increase the medical school students and residents who want to join primary care.

As the medicalization of deviance has expanded, “remedies” have multiplied. Our ‘magic bullets’ now support our norms and values of happiness, sexual potency and youthful energy, cognitive ability and appearance.

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Length: 2 pages, double spaced
Submission:  electronic

As the medicalization of deviance has expanded, “remedies” have multiplied. Our ‘magic bullets’ now support our norms and values of happiness, sexual potency and  youthful energy, cognitive ability and appearance. We have also provided more opportunities for deviance (e.g., human growth hormone has become a street [or gym] drug and pharmaceutical companies have been fined for selling off-label HGH [anti-aging, athletic edge]). In short, we have socially constructed deviance even as we attempt to reduce the stigma of deviance.

Your task:

1.Review Unit VIII (prof’s notes), text resources, Unit I discussion (sports)
2.Review C. Wright Mills (chapter 1, Unit I [prof’s notes])
3.Remember, this is a dialogue: a minimum of three to five entries is expected, first-time late entries prevent dialogue and thus diminish the benefit to you and your colleagues.
Speed Bump comic
Used with permission of Dave Coverly and the Cartoonist Group. All rights reserved. Reprinted online with permission.
4.By Sunday midnight, submit a paper that responds to this question:
How would C. Wright Mills analyze the structural sources of the trouble/issue of “juiced” athletes (use your sociological imagination)? (You will find Conrad’s critique helpful here.)

Rubric file is attached which contains requirements for the paper. Please pay attention, that outline is also required, even though it is not mentioned in the rubric.

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This is an interdisciplinary research paper. It should contain legal and medical perspectives of the issue of abortion. The hypothesis: In the past decades stets like Texas, Alabama, Indiana, North Dakota and Mississippi passed the so called Targeted Regulation of Abortion Providers (TRAP), which rely on complicated and costly regulations as tactic to shut down abortion facilities. Very often these legal decision are not based on solid scientific evidence, but rather on falsified statistics and common misconceptions. However the goal should be not banning or restrictions of abortions, but prevention of unintended pregnancies.

Rubric file is attached which contains requirements for the paper. Please pay attention, that outline is also required, even though it is not mentioned in the rubric.  Also added are Literature search file, which contains bibliography and extracts from different legal sources. In the paper in the Law part you should use Baum, Siefker, Roseberry, Ikemoto. In the Medical part you can use Drey, Finer, Gemzel, Grimes, Grossman.

What makes the pain worse or better: movement makes it worse, lying supine

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Caring for Clients with common Digestive/ Gastrointestinal Health Challenges.

Select any three (3) questions from Case Study # 1 or from Case Study # 2, and discuss the rationale by posting/ responding in the online learning activity/ discussion forum. Please identify the case study selected and copy the three questions chosen directly into the post. Include and properly reference information taken from the course readings to support your ideas.

CASE STUDY #2

(must be 3 pages with at least 5 references no older than 5 years)

Joshua Phelps, 37, arrives at the ED complaining of right lower quadrant abdominal pain. You obtain his vital signs and find out that he has no known allergies and takes no medications. His BP is 156/ 94; pulse, 100 and regular; respirations, 20; and temperature, 99.6 F (37.6 C).

What is the next step in investigating his problem?
Mr. Phelps’ pain began last evening and is associated with nausea, but he hasn’t vomited. Eating doesn’t seem to affect the pain, and he hasn’t had any bowel or bladder changes.

In assessing Mr. Phelps’s pain, what information should you obtain?
Mr. Phelps describes his pain as constant, deep and achy, and worse with movement. On a pain scale of 0- to 10, with 10 being the worst pain he has ever experienced, he rates the pain at a 7. He doesn’t want to lie supine and is guarding his right lower quadrant.

When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?
Abdominal assessment shows a normal inspection, normoactive bowel sounds, and no masses, enlargement, or tenderness of the liver or spleen. However, Mr. Phelps did display rebound tenderness and positive obturator and iliopsoas signs. Based on his history and physical assessment, the healthcare provider orders a complete blood cell count and urinalysis. The results indicate a total white blood cell (WBC) count elevation with 96% neutrophils. The urinalysis is normal.

Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.
Abdominal aortic dissection.
Acute appendicitis.
Renal calculi.
Acute Cholecystitis.

ONE PAGE OF SELF REFLECTION on
What is my knowledge concerning providing care for and with clients experiencing digestive and gastrointestinal challenges? (i am a community rpn)

ONE PAGE OF REFLECTION ON MY PEER WORK ( TWO REFERENCES)
Case Study #2
1) In assessing Mr. Phelps’s pain, what information should you obtain?The information that should be obtained about Mr. Phelps’s pain include:
Character of the pain: deep and achy
Duration: States it’s constant
Frequency
What makes the pain worse or better: movement makes it worse, lying supine
Location: right lower quadrant
Distribution of referred pain
Time pain started: last evening

2) When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?

Start with inspecting the abdomen noting colour, contour, symmetry, the umbilicus is midline etc.
Next we would auscultate because “percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds” (Jarvis, 2014). During auscultation we listen for bowel sounds(character and frequency) and vascular sounds.
Percussion comes next “to assess the relative density of abdominal contents, to locate organs, and to screen for abdominal fluid or masses”(Jarvis, 2014).
Palpation is last. You note whether their is tenderness, masses, involuntary rigidity, guarding etc.

3) Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.

Mr. Phelps’s assessments suggest acute appendicitis based on the following findings:positive obturator and iliopsoas sign, pain in RLQ. “when the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix) pain is felt in the RLQ” (Jarvis, 2014)
Rebound tenderness 
Pain aggravated by movement
Nausea
Fever
Total white blood cell count elevation with 96% neutrophils 

References

Jarvis, C. (2014). The Abdomen, Physical Examination and Health Assessment (2nd CanadIan ed., pp 557-569). Toronto, ON: Elsevier Canada.