Otitis Media is classified as any inflammation of the middle ear characterized by the accumulation of infected fluid in the middle ear, bulging eardrum, and pain in the ear. Otitis Media, which is also known as a middle ear infection, is the second most common disease of childhood after upper respiratory infection (Otitis Media, 2017). The middle ear is a small space behind the eardrum that is supposed to be well ventilated by air. Air normally passes up from behind the nose, through the Eustachian tube in order to keep the middle ear dry and clean (“Understanding Ear Infections - the Basics”, n.d.). However, when there is not enough fresh air ventilating the middle ear causing the Eustachian tube to be clogged and blocked, it becomes damp, still and warm, which causes the infection.
Epidemiology of Otitis Media
It is much more common in children and infants because their Eustachian tube is…...

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References

“Otitis Media.” (2017, October 18). Medscape. Retrieved December 01, 2017, from

Philadelphia, T. C. (2014, May 05). Otitis Media with Effusion (OME). Retrieved December 01, 2017, from http://www.chop.edu/conditions- diseases/otitis-media-effusion-ome

“Understanding Ear Infections -- the Basics.” (n.d.). WebMD Retrieved December 05, 2017, from https://www.webmd.com/cold-and-flu/ear-infection/understanding-otitis-media-basics#1

https://emedicine.medscape.com/article/994656/overview?pa=e7%2BHyhjaKi5kXPCHgzrSWtOQ7XMaWaM%2BrHb%2FWZGFvTNuYgaWBD0SZJq9im84Wg%2BrHnIoM8a%2BOnfqLYTcSUU9MAf1%2FT5AOtgCo%2FGiWn3Mk%2BU%3D

Differential Diagnosis for Ears
My differential diagnosis is largely predicated on the concept of otitis media, which the patient was treated for in the past year and is fairly common in children (Woo et al., 2014, p. 1). Although it is relatively clear from the symptoms that Mark is experiencing some form of ear infection, it is necessary to distinguish exactly which type he is encountering this particular time around. I would consider the possibilities that Mark has either acute or chronic otitis media. It is obvious that he has suffered from this affliction in the past, which lends credibility to the possibility that he is likely suffering from the chronic form of this condition. Chronic otitis media symptoms follow those of the acute variety. Moreover, they are frequently not accompanied by the sort of fever that is often present with the acute form of this condition. Likely, the bacteria that…...

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References

Ting, C., Huang, K., Tzeng, Y. (2016).

Correlation between video-otoscopic images and tympanograms of patients with acute middleear infection. Indian Journal of Otology. 22(1), 10-13.

Woo, J.I., Oh, S., Webster, P, Lee, Y.J., Lim, D.J., Moon, S.K. (2014). "NOD2/RICK-dependent ?-defensin 2 regulation is protective for nontypeable Haemophilus influenzae-induced middle ear infection." Plos One. 9(3), 1-11.

I would, for example, implement a system of diagnosis that very clearly indicates the proper approach to be taken. Once an approach has been selected, the parent or guardian will be fully informed of his or her responsibilities. In the watchful waiting approach, for example, I would provide the parent or guardian with a sheet of criteria that must be followed in observing the child. Keeping in mind that few parents are medical professionals, I would recommend that they call the hospital immediately if they have any doubt about the health of their children. In order to do this successfully, parents will be provided with a 24-hour access to the relevant medical professionals should they need help or advice.
Depending upon the severity of the illness, I might even recommend that the child in question spend a few hours in the hospital to have professionals close by to monitor the…...

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References

American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical Practice Guideline: Diagnosis and Management of Acute Otitis Media. Pediatrics, Vol. 113, No. 5.

Bain, J. (2001, Feb.) Treatment of acute otitis media: are children entered into clinical trials representative? British Journal of General Practice. Retrieved from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313930/pdf/11217628.pdf 

Board on Health Sciences Policy (2004). The Ethical Conduct of Clinical Research Involving Children Institute of Medicine

Johansen, E.C.J., Lidholdt, T., Damsbo, N. And Eriksen, E.W. (2000, Mar. 13). Tympanometry for diagnosis and treatment of otitis media in general practice. Family Practice. Retrieved from:  http://fampra.oxfordjournals.org/content/17/4/317.full

The chief concern of the researcher should be the safety of the research participant. This is carried out by carefully considering the risk to benefit ratio, using all available information to make an appropriate assessment and continually monitoring the research as it proceeds.

The scientific researcher must obtain informed consent from each research participant. This should be attained in writing although oral consents are sometimes acceptable after the participant has had the chance to carefully consider the risks and benefits and to ask any pertinent questions. Informed consent ought to be seen as an ongoing process, not a singular event or a mere formality.

The researcher must list how privacy and confidentiality concerns will be approached. esearchers must be receptive to not only how information is protected from unauthorized observation, but also if and how participants are to be notified of any unexpected findings from the research that they may or may…...

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References

American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical

Practice Guideline: Diagnosis and Management of Acute Otitis Media. Retrieved March

20, 2010, from Web site:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451

Virological tests indicated that in all (64.6%) or 558 of 864 URI specimens were positive for viruses. Results from the tests showed that Adenovirus and rhinovirus were the most common viruses associated with URI. However, the results further revealed that coronavirus, RSV and adenovirus were the three most commonly associated virus types in URI complicating AOM. This result is in concurrence with previous studies by Henderson et al., Heikkinen et.al etc. Adenovirus was responsible for almost 23.6% of AOM, while RSV was implicated in 15.8% of the cases of Otitis media. The high rates of these two viruses and their association with AOM incidence offers new implications for treatment of URI in children. The Overall results from this study indicate that over 61% of the URI is OM complicating with 37% AOM and 24% OME respectively. OM complication was manifest in 50% of children with URI by adenovirus, coronovirus and…...

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Bibliography

1) Tasnee Chonmaitree, M.D., Krystal Revai & James J. Grady et.al (2008), 'Viral Upper respiratory tract infection and Otitis Media complication in Young Children'  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744371/

Other signs include a child who has numerous of colds and ear infections; a child who speaks overly loudly; frequently asks for words or phrases to be repeated and who does not understand someone unless the person is facing him or her. (Hearing Health for Children)
While ear infection is usually treated with prescription antibiotics, many physicians state that use of these media is not a good idea at an early age. As one experts states, "Contrary to common practice, most children with ear infections should not be treated with antibiotics..." (DrGreene Content:

evolution in Ear Infection Treatment). These findings refer to guidelines released by the American Academy of Pediatrics and the American Academy of Family Physicians in 2004, which state that, "...currently in the United States there are more than 10 million antibiotic prescriptions for the 5 million ear infections diagnosed in children each year - about half of all…...

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References

Dr Greene Content: Revolution in Ear Infection Treatment. Retrieved April 9, 2008 at  http://www.drgreene.com/21_1769.html 

Ear infection (acute otitis media) Retrieved April 9, 2008, at  http://www.webmd.com/hw-popup/ear-infection-otitis-media 

Hearing Health for Children. Retrieved April 9, 2008, at http://www.northwords.com/Hearing.htm

How to Clean Your Preschooler's Ears. Retrieved April 9, 2008, at  http://preschoolrock.com/index.php/health_exercise/clean_ears

new issues to light in tems of knowledge and infomation. The Intenet, SmatPhones, and technology have inceased the ability fo infomation to be both pocessed and disseminated. Howeve, this is challenging because it equies that the infomation be vetted, and that individuals can citically analyze soucing and context. This is paticulaly tue now that almost eveyone has access to health infomation fom websites, popula pess, and even blogs (Health on the net, 2013).
When we examine souces, though, we need to take into account the vetting (bias, pupose, etc.) but also the obustness and quality of the souces. The coe aspect of this tend in analyzing infomation is to use citical thinking skills to pocess infomation. In geneal, the basic aspect of citical thinking is to analyze the souce mateial and decide upon its veacity and elevance. Cetainly, it is not as easy to ead, wite, and pocess citically, one…...

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references, is not selling anything, and has clinical practice guidelines. This should be a credible source; 2) Kidshealth is part of the Nemours foundation, established in 1936 and affiliated with a number of hospitals. While there are no citations, the language used is layperson friendly, with illustrations appropriate to share with children. This would be a valid site to scan for basic information, knowing that it may not always be written by medical personnel.

The key with clients is to allow them to understand sourcing of documents. Many have never been asked to vett sources, many simply believe what the read on the internet. By providing a skilled set of critical thinking strategies, one can alleviate a number of dangerous misunderstandings.

Sources:

Austhink. (2008, September 8). Critical Thinking on the Web. Retrieved from austhink.com:  http://austhink.com/critical/ 

Health on the Net Foundation. (2013). Information. Retrieved from:  http://www.hon.ch/

Teaching Children with Hearing Difficulties: Evidenced-Based Practice Early evaluation and detection for hearing difficulties forms the basis for timely intervention. This text emphasizes the need for early intervention as a way of maximizing the linguistic competence and literacy development of children with hearing difficulties. It covers the JCIH position statement and uses research evidence to demonstrate how early audiological intervention could help promote academic outcomes for children with hearing difficulties.
Reaction to the JCIH 2007 Position Statement
The JCIH position statement advocates for early evaluation and diagnosis of auditory problems for children with hearing loss. Early hearing loss detection and intervention helps to maximize the literacy development and linguistic competence of children with hearing difficulties, thus helping to enhance their academic and social outcomes. Studies have, in fact, shown that children whose hearing problems are diagnosed early (before 2 months of age) and intervention initiated have better functional, language, and speech outcomes than…...

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References

American Psychological Association (2010). Publication Manual (7th ed.). Washington, D.C.: American Psychological Association.

Cole, E. & Flexer, C. (2016). Children with Hearing Loss: Developing Listening and

Talking (4th ed.). San Diego, CA: Plural Publishing, Inc.

Cupples, L., Ching, T., Crowe, K., Seeto, M., Leigh, G., Street, L., Day, J., Marnane, V., & Thomson, J. (2013). Outcomes of 3-Year-Old children with Hearing Loss and Different types of Additional Liabilities. The Journal of Deaf Studies and Deaf Education, 19(1), 20-39.

Dobie, R. A., & Hemel, D. (Eds.). (2004). Hearing Loss: Determining Eligibility for Social Security Benefits. Washington, D.C.: National Academies Press.

Easterbrooks, S. & Estes, E. (2007). Helping Deaf and Hard of Hearing Students to Use

Spoken Language. Thousand Oaks, CA: Corwin Press.

NIH (2014). Enlarged Vestibular Aqueducts and Childhood Hearing Loss. National Institute on Deafness and Other Communication Disorders. Retrieved from  https://www.nidcd.nih.gov/sites/default/files/Documents/health/hearing/NIDCD-Enlarged-Vestibular-Aqueducts-and-Childhood-Hearing-Loss%20.pdf

The brain while expanding pushes the skull outward in the same perpendicular to the closed structure. This will be marked by the occurrence of 'papilledema' 'pseudoproptosis' as also 'optic atrophy.' (39) This results in the orbital socket being smaller and the eyes getting 'protoposed'. The intercranial pressure is bound to be high. The symptoms in such cases will be optic atrophy, head ache and papilledema. Or in the case of 'Crouzon's disease' where occurs a marked hooked nose and a frontal lobe which makes the disease also called the parrot head disease. Surgery in both these types of situations become mandatory as the result of the cranial pressure could result in death. (39)
egarding the facial surgery discussions always centre on perfecting features and cosmetic changes. The debate must rather be on the goals of the surgery and the overall benefits that can accrue to the patient in terms of…...

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References

1. Buncke HJ. Facial Paralysis - Reanimation. California Pacific Medical Center. [online]. 2007 [cited 2008 Feb 16]. Available from: URL:

 http://www.cpmc.org/advanced/microsurg/procedures/facial-animation.html 

2. Sataloff J, ThayerSataloff R. Occupational Hearing Loss. CRC Press. 2006.

Kim JYS, Bienstock a, Ketch L. Facial Nerve Paralysis, Dynamic Reconstruction. [online]. 2007 [cited 2008 Feb 16]. Available from: URL:

496).
Evidence-based practice indicates the universal need for the implementation of better maternal and newborn infant care, especially with regard to breastfeeding support and encouragement. This is evidenced by countless research works that both report the optimized goals of better rates of exclusive breastfeeding among infants 0-6 months and the evidence of current trends and practices (AAP, 2010; Scanlon et. al, 2007; Naylor, 2010; Grummer-Strawn & Shealy 2009). These researchers, reviewers an experts base their observations on a need that is well documented in the literature, i.e. both the current state of breastfeeding support in maternity settings and clinical short- and long-term health related outcomes associated with breastfeeding and lack of breastfeeding. The literature associated with this need is demonstrative of many issues regarding breastfeeding and support that the best overall scenario for maternal and infant health is exclusive breastfeeding of infants till six months of age with supplements or…...

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Resources needed for the implementation of the Baby Friendly Hospital designation are relatively limited, due in large part to the extensive work the Brookdale Hospital has recently done to begin to implement better breastfeeding and maternal practices, as noted at the close of the Problem statement section of this work. The hospital must implement additional changes, file the proper application for assessment and designation and prove and justify implementation of the 10 steps associated with the designation over a period of five years. The resources needed for this process will include participation by existing staff including nurses, nurse managers and the hiring of a certified lactation specialist. The most costly of all the implementation strategies will be hiring of a certified lactation specialist, other costs will be further detailed in the budget section of this work and will include administrative, office supplies, additional signage and support training of nursing and support staff.

Barriers to Change

Barriers to change must begin with a clear understanding and elimination of the kinds of hospital practices that are shown in evidence-based research to be particularly contraindicative of early, long-duration and successful breastfeeding including the; use of artificial nipples (pacifiers), bottles, and even nipple shields in mainly healthy newborns (McKechnie & Eglash, 2010) supplementation that is unneeded for natal nutrition, limitations in the practice of rooming in (infant stays with mother as much as possible over the first 24 hours after birth to ensure on demand nursing opportunities), limitations in skin to skin contact of infant with both mother and father, and other institutionally practiced barriers are not only common but traditionally accepted as standards of practice in most hospitals and birthing centers ("Breastfeeding-related maternity practices…" 2008 ). The Baby-Friendly Hospital Designation, and all the steps to prepare and implement it will go far to demonstrate change in hospitals including but not limited to Brookdale Hospital in NYC.

Barriers to change, that are specific to Brookdale hospital have been briefly developed in the problem statement of this work and demonstrate mostly institutional practices that are not only accepted but supported by the hospital and L&D and neonatal staff. Rooming in, where the newborn infant spends as much time as possible with the mother during the first 24-48 hours of life, leaving the bedside of the mother only when absolutely necessary is essential to change. The existence of a highly staffed and large newborn nursery, where infants spend a good deal of time and receive a great deal of care from staff rather than the mother is one of the first institutional issues that needs to change. This reduction of reliance on the newborn nursery may offset some of the costs of implementing change, as stricter rooming in policies and practices would indicate the need for fewer staff resources in the newborn nursery. Skin-to-skin contact of mother to infant should begin at the moment of birth, as is indicated by the hospital's new policies and procedures for breastfeeding support. Newborns should be given screening tests in the presence of the mother, and if at all possible while the mother is holding and/or nursing the child during skin to skin contact. Breastfeeding education should be continuous, beginning in prenatal clinics, extending throughout the hospital stay and supported and supplemented by follow up care with a certified lactation specialist and/or nursing staff that has taken CEC courses in breastfeeding support, and the number class offerings per week should be increased to every other day to support the usual uncomplicated discharge of mother and baby at 48-72 hours post delivery and the course for mothers should be a condition for discharge. L&D and nursery nurses should continue to be encouraged to take the available course with a first year goal of 100% completion. Lastly, cultural barriers to breastfeeding in the patient population should be mitigated with culturally sensitive training and breastfeeding support, long-term breastfeeding follow up and a sensitive but essential reiteration of the many benefits of breastfeeding for both child and mother, reiteration, for those who qualify, of the benefits of the Women Infant Children program which supports breastfeeding mothers with additional food and benefits for the mother not just by supplying formula or food for the infant after birth.

Role of Nurse Executive

" (Stone, 2006) Treatment is stated by Stone (2006) to be "diagnosis dependent and may be medical or surgical." Practical modifications include simple steps such as crushing of pills or opening of capsules to ease and facilitate swallowing.
The work of Leibovitz, et al. (2007) entitled: 'Dehydration Among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia" states that long-term care (LTC) residents in the nursing home "especially the orally fed with dysphagia are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly." (Leibovitz, et al., 2007) it is related however that "combinations of these indices are more reliable." (Leibovitz, et al., 2007) the study reported by Leibovitz et al. is one that assessed hydration status among elderly LTC residents with oropharyngeal dysphagia and in which a total of 28 orally fed…...

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Bibliography

Spieker, Michael R. (2000) Evaluating Dysphagia. American Family Physician 14 Jun 2000. Online available at  http://www.aafp.org/afp/20000615/3639.html 

Marik, Paul E. And Kaplan, Danielle (2003) Aspiration Pneumonia and Dysphagia in the Elderly. Chest. July 2003. Vol. 1224, No. 1. Online available at http://www.chestjournal.org/content/124/1/328.full

Bautmans, I., et al. (2008) Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. J. Rehabil Med. 2008 Oct;40(9):755-60. PubMed Online available at  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18843429 

Stone, Rebecca S. (2006) Dysphagia in the Elderly. Inpatient Times. October 2006. Online available at  http://www.bmc.org/geriatrics/RStone_DysphagiaintheElderly.pdf

Jack used some elements of guilt surrounding his hospitalization in an attempt to persuade his mother to get him a treat at the cafeteria. This attempt to maintain control over his mother is appropriate to this developmental age according to Erickson's stages of development, and Donna easily managed his request by explaining that his diet was restricted prior to surgery. Jack was able to accept this answer, but continued to request assurances he would obtain the treat later in the day. Jack responded appropriately to all staff requests and his behavior appeared age appropriate and unremarkable. He maintained eye contact with staff and initiated conversation on several occasions.
The staff provided some coloring books and paper for Jack once he was confined to his bed in preparation for surgery. Jack appeared to be able to manage crayons without difficulty and easily wrote his name in block capital letters which were…...

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Reference:

Siddiqui a. (1995) Object Size as a Determinant of Grasping in Infancy. Journal of Genetic Psychology, Vol. 156 "http: Marcia, J.E., (1966), Development and validation of ego identity status, Journal of Personality and Social Psychology 3, pp. 551-558

Centers for Disease Control (2000), 2-20 years. Stature for age and weight for age percentiles. Accessed via the Internet at www.cdc.gov/nchs/data/nhanes/growthcharts/set1clinical/cj41l021.pdfon 23 June 2007

I. Personal. 3:551-8, 1966.

Flandes-Stepans, M., Wilhelm, S.L., & Dolence, K. (2006). Smoking Hygiene: Reducing Infant Exposue to Tobacco. Biological eseach fo Nusing, 8(2), 104-114.
Consideing the title of the wok, one would believe that the poblem statement would explain ways to educe infant exposue; when in fact the aticle commences by explaining the lage monetay buden that smoking elated issues has bought about in the medical field. The aticle then begins to explain the coelation that exists between the smoking patten of the mothe and the level of exposue to Envionmental Tobacco Smoke (ETS). Finally, it is explained that a stong coelation has been made between beastfeeding and educed ETS; howeve it is also stated that in fact a child is moe likely to have elevated levels & symptoms associated with ETS if the beastfeeding mothe is a smoke. It is also stated that thee is a distinct coelation between the smoking patten…...

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references utilized in this article there could have been more useful information provided from these sources. In addition, considering the fact of the redundancy of this research compared to the previous research it would have been an improvement to look at another alternative to decreasing ETS. Though the title of the research would lead one to believe that this will in fact be about ways to decrease ETS, this is not what is truly portrayed in the research in the beginning. The reader is given information as to how much money ETS is costing medically due to health issues and infant related deaths, but very little discusses the impact that breast feeding has. It appears in the beginning that the researchers want to prove that children should be breastfeed and that mothers should not smoke because the infants that are breastfed are protected from the health problems associated with ETS. However little information is given neither in the intro nor in the review of literature to show what impact there really is for a child that is breastfed by a mother that does not smoke, in relationship to ETS from second hand sources i.e. cars, malls etc. Another weakness, which I have already discussed several times through this critique, is the sample size. This was a rather small sample and the ways in which the control and test group were handled may not have been the best methods possible. Ultimately, this research left me wondering why one would want to conduct research to confirm the already obvious, while offering no additional information to the resolution or problem at hand.

Reference

Flanders-Stepans, M., Wilhelm, S.L., & Dolence, K. (2006). Smoking Hygiene: Reducing Infant Exposure to Tobacco. Biological research for Nursing, 8(2), 104-114.

Controversy with vaccines, adverse reactions of the MM vaccine and the negative publicity surrounding it
SHAPE

Measles, Mumps and ubella Vaccine:

Absence of Evidence for Link

to Autistic-Spectrum Disorders

Henry K. Nguyen, MD Candidate

Increased incidence of measles, mumps, and rubella is directly due to controversies regarding the measles, mumps, and rubella vaccine despite the absence of data supporting a correlation between this combined vaccine and development of autism.

Correspondence to:

Mentor:

Dr. Anshu Kacker

5650 including Abstracts

Increased incidence of measles, mumps, and rubella is directly due to controversies regarding the measles, mumps, and rubella vaccine despite the absence of data supporting a correlation between this combined vaccine and development of autism.

Methods and materials: A literature search was performed using key phrases, including the search-requisite abbreviation 'MM' (measles, mumps, rubella), such as: 'autism mmr vaccine', 'colitis mmr vaccine', 'controversy mmr', 'mmr adverse results', 'vaccines autism-spectrum disorders', 'vaccine effects mmr', 'vaccine measles', and 'vaccine rubella'. The results were compiled, following which…...

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References

Anderberg, D. (2009). Anatomy of a Health Scare: Education, Income and the MMR Controversy in the UK. Wrong source cited -- found article ===> Journal of Health Economics 03/2011; 30(3):515-30. DOI: 10.1016/j.jhealeco.2011.01.009

Andrews, N.,Miller, E., Taylor, B., Lingam, R., Simmons, A., Stowe, J., Waight, P. (2002). Recall bias, MMR, and autism. Arch Dis Child, 87, 493-4.

ADDED

Autism Watch (2015)  http://www.autism-watch.org/news/lancet.shtml

A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes. OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water.

If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type…...

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Works Cited

Braunald, Eugene., Fauci, Anthony S., Kasper, Dennis L., Hauser, Stephen L., Longo, Dan L., Jameson, J. Larry. 2001. Harrison's Principle of Internal Medicine, 15th ed. New York: McGraw-Hill Medical Publishing Division.

The Merck Manual (16th ed.). (1995). Portland, Oregon: Merck & Co., Inc.