Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on  Patient psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

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Depression Scenario

The interactive depression scenario described a 70-year-old male who presented with complaints of depression (Laureate Education, 2019). He also reported shoulder pain related to warehouse labor, experiencing the death of his mother at a young age, being an outsider at school, anhedonia, recent weight gain, insomnia, and poor concentration (Laureate Education, 2019). On exam, he had poor eye contact, soft speech, constricted effect without evidence of psychosis or suicidal/homicidal ideation (Laureate Education, 2019). For the first decision, I chose to start the patient on Zoloft 25 mg oral daily. When the patient returned four weeks later with a 25 percent improvement of depressive symptoms and a new onset of erectile dysfunction, I chose to add Wellbutrin IR 150 mg in the morning. When the patient came in four weeks later with the continued decrease of depressive symptoms, no erectile dysfunction, and feelings of increased nervousness, I chose to change the Wellbutrin order to Wellbutrin XL 150 mg oral in the morning to address the Patient psychological disorder and provide recommendations for alternative drug treatments.

Pharmacotherapeutic Impact on Pathophysiology

When choosing initial treatment options for depression, the classes of medications have similar efficacy, so it is best to focus on safety and medication tolerance (Rosenthal & Burchum, 2018). Therefore, I chose to start with a Selective Serotonin Reuptake Inhibitor (SSRI), recognized as the safest and most tolerated medication for treating major depression (Rosenthal & Burchum, 2018). The pathophysiology of these medications is unclear; however, the theory suggests that these medications compensate for serotonin deficiency in the synapse (Holck, Wolkowitz, Mellon, Reus, Nelson, Westrin, & Lindqvist, 2019). Serotonin is needed to regulate sleep, mood, and cognition (Holck et al., 2019). By increasing the amount of Serotonin in the synapse, this patient’s depressive symptoms decreased.  In the second decision, I chose to add Wellbutrin IR to the patient’s medication regimen to help treat his erectile dysfunction symptoms. Wellbutrin is an atypical antidepressant where the mechanism of action is also not understood (Rosenthal & Burchum, 2018). However, the effects may be related to blocking the reuptake of dopamine, which regulates behavior and influences learning, and norepinephrine, which plays a role in getting the brain and body ready for action (Berke, 2018; Rosenthal & Burchum, 2018). While Wellbutrin helps depression, it also seems to help with sexual desire (Rosenthal & Burchum, 2018). Fortunately, this additional medication helped the patient in the scenario. After four weeks of taking both drugs, he had a continued decrease in depressive symptoms and no longer struggled with sexual dysfunction.           In my third decision, I chose to change the Wellbutrin order to extended-release since the patient was experiencing restlessness symptoms. The immediate release may have been too much, too fast for the patient as it reaches its peak two hours after administration (Rosenthal & Burchum, 2018). Extended-release Wellbutrin reaches its peak at five hours with a half-life of approximately 21 hours (Food and Drug Administration, n.d.). This change will help to settle the experienced side effects of the medication.

Treatment Plan The effect of Zoloft and Wellbutrin on the patient’s pathophysiology will impact the patient’s treatment plan. Common side effects of SSRIs include weight gain, insomnia, sexual dysfunction, and increased risk of suicide (Rosenthal & Burchum, 2018). I already addressed sexual dysfunction by adding Wellbutrin, but the monitoring for the other side effects is also essential for safety and compliance purposes. The patient already has had a significant amount of weight gain and complains about insomnia. Therefore, follow-up appointments are necessary for close monitoring of these possible side effects. Treatment should include education about proper diet and activity to regulate weight. The provider should also assess the patient’s sleep to ensure the medication is helping rather than worsening the amount and quality of sleep. It is also crucial for the provider to educate the patient on the increased risk of suicide and encourage the patient to seek help immediately if he starts having these thoughts. The provider should assess the patient for suicidal ideation frequently.

Wellbutrin is usually well tolerated; however, it carries a risk for seizures and psychotic symptoms. Therefore, the provider should assess for any seizure risk factors such as a history of seizures, a head injury, an eating disorder, or a CNS tumor (Rosenthal & Burchum, 2018). The provider should also assess the patient for psychotic symptoms at each follow-up visit, such as hallucinations or delusional thoughts (Rosenthal & Burchum, 2018).

References

Berke, J.D. (2018). What does dopamine mean? Nature Neuroscience, 21(6), 787-793. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29760524Food and Drug Administration. (n.d.). Wellbutrin XL. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021515s026s027lbl.pdfHolck, A., Wolkowitz, O. M., Mellon, S. H., Reus, V. I., Nelson, J. C., Westrin, Å., & Lindqvist, D. (2019). Plasma serotonin levels are associated with antidepressant response to SSRIs. Journal of Affective Disorders, 250, 65–70. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2019.02.063Laureate Education (Producer). (2019). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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Patient Psychological disorder and Alternative Drug Treatments

When assessing community health issues of specific population groups, it is important to identify what may be involved and ensure they are captured in the overall assessment. What is a targeted or high-risk population group? How would you identify this population group in a community? Why is it necessary to focus on these groups? Provide 2-3 examples of this type of population.

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Assessing community health issues on Specific population groups

Quality multidimensions and its perspectives in an organisation of various stakeholders, including patients and families. As noted in this week’s Learning Resources, defining quality is not a simple, straightforward task. Yet, it provides an essential foundation for being able to measure and assess quality, and, ultimately, to improve it.

In this Discussion, you consider definitions and measurements of

. As you proceed, think about why it is important for organizations to be able to quantify quality and compare current performance to previous performance, to a set of standards, and/or to performance in other organizations.

To prepare:

• Review the information in the Learning Resources, especially the chapters in the Sadeghi, Brazi, Mikhail, and Shabot course text, focusing on how quality is or could be defined and measured.
• Think about a health care organization with which you are familiar. It may be the same organization you are focusing on for your Course Project or a different one. How do you think various stakeholders in this organization would define quality? How would you define quality as it relates to this organization?
• Review the information on quality standards and/or aims in the Learning Resources, and consider the following:
  • Which outcomes related to quality are currently being monitored in the organization that you have selected?
  • How is related data collected and evaluated?
  • Does the organization use health information technology in this regard? If so, how?
  • How is quality-related information (e.g., data, needs for improvement) communicated throughout the organization?
  • What do you consider to be the strengths and weaknesses of the current approach to quality in this organization?

By Day 3

Post a definition of quality, Quality Multidimensions and its Perspectives in an organisation. Describe at least one quality-related measure that is currently being monitored within the organization and summarize the data collection process for this measure, and explain how this information is communicated to or among the staff. Identify at least one strength and one weakness related to how quality is defined, measured, and/or monitored within the organization.

only needs to be around 300 words

optional resources

Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R. C., & Stark, L. J. (2010). Sustained improvement in pediatricians’ ADHD practice behaviors in the context of a community-based quality improvement initiative. Children’s Health Care, 39(4), 296–311.

Gardner, K., Bailie, R., Si, D., O’Donoghue, L., Kennedy, C., Liddle, H., . . . Beaver, C. (2011). Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process. The Australian Journal of Rural Health, 19(3), 111–117.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Knox, L. M., & Aspy, C. B. (2011). Quality improvement as a tool for translating evidence-based interventions into practice: What the youth violence prevention community can learn from healthcare. American Journal of Community Psychology, 48(1-2), 56–64.

http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

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Quality Multidimensions and its Perspectives in an organization

Research Articles that are supporting your PICOT question in type-2 diabetic patients. There are 4 articles provided only 2  needed and it only has to be one paragraph. And it also has to go through to turn it in. So please no plagiarism.

On the discussion board, using a minimum of two articles that are supporting your PICOT question, submit one paragraph synthesizing the research into clear, concise statements without separately reviewing each of the studies in the paragraph—but by paraphrasing and synthesizing the work that was done.

PICOT: In type-2 diabetic patients, how does the ketogenic diet compare to a low-calorie diet in the maintenance of weight loss in a one-year time frame?

Comments from the teacher:

Wow!  This week’s assignment was evidently one that no one understood.  May I suggest you go back and at least read the lectures posted on week 6!  This lecture stated:

To synthesize is to combine two or more elements to form a new whole. In the literature review, the “elements” are the findings of the literature you gather and read; the “new whole” is the conclusion you draw from those findings.

“Rigorous methods of quantitative assessment are necessary to establish interventions that are both effective and cost-effective. Usually, a single study will not fully address these issues and it is desirable to synthesize evidence from multiple sources.

At this point in the process, you should aim for the synthesis of the material. Synthesizing means comparing different materials and highlighting similarities, differences, and connections. When a writer synthesizes successfully, he or she presents new ideas based on interpretations of other evidence or arguments. Critical reading and critical thinking are key components of successful synthesizing.’

Please look at your paragraph and see if you did this (hint:  most of you did not!)

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  Articles that are supporting your PICOT question in type-2 diabetic patients

Discussion of the epidemiology of allergies and treatment options

A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.”

Please answer the following questions in a narrative format:

1. Discuss the epidemiology of allergies.
2. What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.
3. What education will you provide to the patient?

1 initial post, 2 replies using APA 6th format. 300 words, 2 references not older than 5 years.

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Discussion of the epidemiology of allergies and treatment options