CCH_Increasing Access to Lifesaving Diarrhea Treatment

Increasing Access to Lifesaving Diarrhea Treatment

A summary of the work led by the Diarrhea Innovations Group, housed at PATH, to submit an application to the World Health Organization's Model List of Essential Medicines for Children for the addition of co-packaged oral rehydration solution (ORS) and zinc as an individual listing. The addition of a co-packaged listing has the potential to reinforce the lifesaving benefits of ORS and zinc in managing childhood diarrhea as a cornerstone for all health care systems involved in diarrhea management.

Corporate author(s): PATH

Publication date: November 2018

Increasing access to lifesaving diarrhea treatment: Proposal for inclusion of co-packaged ORS and zinc on the World Health Organization Model List of Essential Medicines for Children

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CCH_Anatomy _Muscles of the Upper Extremity and Lower extremity

Muscles of the Upper Extremity

The muscles of the upper extremity include those that attach the scapula to the thorax and generally move the scapula, those that attach the humerus to the scapula and generally move the arm, and those that are located in the arm or forearm that move the forearm, wrist, and hand. The illustration below shows some of the muscles of the upper extremity.

Muscles that move the shoulder and arm include the trapezius and serratus anterior. The pectoralis major, latissimus dorsi, deltoid, and rotator cuff muscles connect to the humerus and move the arm.

The muscles that move the forearm are located along the humerus, which include the triceps brachii, biceps brachii, brachialis, and brachioradialis. The 20 or more muscles that cause most wrist, hand, and finger movements are located along the forearm.

Muscles of the Lower Extremity

The muscles that move the thigh have their origins on some part of the pelvic girdle and their insertions on the femur. The largest muscle mass belongs to the posterior group, the gluteal muscles, which, as a group, adduct the thigh. The iliopsoas, an anterior muscle, flexes the thigh. The muscles in the medial compartment adduct the thigh. The illustration below shows some of the muscles of the lower extremity.

Muscles that move the leg are located in the thigh region. The quadriceps femoris muscle group straightens the leg at the knee. The hamstrings are antagonists to the quadriceps femoris muscle group, which are used to flex the leg at the knee.

The muscles located in the leg that move the ankle and foot are divided into anterior, posterior, and lateral compartments. The tibialis anterior, which dorsiflexes the foot, is antagonistic to the gastrocnemius and soleus muscles, which plantar flex the foot.

Review: Introduction to the Muscular System

Here is what we have learned from Introduction to the Muscular System:

• One of the most predominant characteristics of skeletal muscle tissue is its contractility and nearly all movement in the body is the result of muscle contraction.
• Four functions of muscle contraction are movement, posture, joint stability, and heat production.
• Three types of muscle are skeletal, smooth, and cardiac.
• Each muscle fiber is surrounded by endomysium. The fibers are collected into bundles covered by perimysium. Many bundles, or fasciculi, are wrapped together by the epimysium to form a whole muscle.
• Muscles are attached to bones by tendons.
• Muscle features such as size, shape, direction of fibers, location, number of origin, origin and insertion, and action are often used in naming muscles.
• Four major muscle groups of the body include:
  • Muscles of the head and neck;
  • Muscles of the trunk;
  • Muscles of the upper extremity; and
  • Muscles of the lower extremity.

CCH-Asking Searchable, Answerable Questions

Asking Searchable, Answerable Questions Finding the right information amidst an overwhelming amount of information in a timely way is imperative. The first step to accomplish this goal is to formulate the clinical issue into a searchable, answerable question. It is important to distinguish between the two types of questions that clinicians might ask—background questions and foreground questions.

 Background questions are those that need to be answered as a foundation for asking the searchable, answerable foreground question . Background questions are described as those that ask for general information about a clinical issue.

 This type of question usually has two components: the starting place of the question (e.g., what, where, when, why, and how) and the outcome of interest (e.g., the clinical diagnosis). 

An example of a background question is: How does the drug acetaminophen work to affect fever? 

{Acetaminophen is an analgesic and antipyretic drug that has almost no anti inflammatory effects. Its mechanism of action is unknown, but it is thought to act centrally through inhibition of the enzymes cyclooxygenase (COX) type 3 (constitutive) and COX-2b (inducible)}

The answer to this question can be found in a drug pharmacokinetics text. Another example of a background question is: How does hemodynamics differ with positioning? This answer can be found in textbooks, as well. Often, background questions are far broader in scope than foreground questions. Clinicians often want to know the best method to prevent a clinically undesirable outcome. For example, What is the best method to prevent pressure ulcers during hospitalization? This question will lead to a foreground question, but background knowledge is necessary before the foreground question can be asked. In this example, the clinician must know what methods of pressure ulcer prevention are being used. Generally, this information comes from knowledge of what is being used in clinicians’ practices and what viable alternatives are available to improve patient outcomes or it may come from descriptive research, such as survey research. Once the methods most supported are identified, clinicians can formulate the foreground question and ask, between the two most effective methods of pressure ulcer prevention, which one will work best in my population? If a clinician does not realize that the question at hand is a background question, time may be lost in searching for an answer in the wrong haystack (e.g., electronic evidence databases versus a textbook). Foreground questions are those that can be answered from scientific evidence about diagnosing, treating, or assisting patients in understanding their prognosis. These questions focus on specific knowledge. In the first two background question examples, the subsequent foreground questions could be: In children, how does acetaminophen compared to ibuprofen affect fever? and In patients with acute respiratory distress syndrome, how does the prone position compared to the supine position affect hemodynamic readings? The first question builds on the background knowledge of how acetaminophen works but can be answered only by a study that compares the two listed medications. The second question requires the knowledge of how positioning changes hemodynamics (i.e., the background question), but the two types of positioning must be compared in a specific population of patients to answer it. 

The foreground question generated from the third background question example could be: In patients at risk for pressure ulcers, how do pressure mattresses compared to pressure overlays affect the incidence of pressure ulcers? The answer provided by the evidence would indicate whether pressure mattresses or overlays are more effective in preventing pressure ulcers. The most effective method will become the standard of care. Recognizing the difference between the two types of questions is the challenge. 

 a novice may need to ask primarily background questions.

 As one gains experience, the background knowledge grows, and the focus changes to foreground questions.

 Although background questions are essential and must be asked, it is the foreground questions that are the searchable, answerable questions

CCH Care of the Woman with Reproductive Health Conditions

Care of the Woman with Reproductive Health Conditions 
Assessment and Care of the Man Concerned about Sexually Transmitted Infection

Care of the Woman with an Abnormal Mammogram..

Care of the Woman with Abnormal Cervical Cytology

Care Of the Woman with Abnormal Uterine Bleeding.

Care Of the Woman with Amenorrhea...

Care of the Woman with Bacterial Vaginosis

Care of the Woman with a Breast Mass

Care of the Woman with Chlamydia

Care of the Woman Undergoing Colposcopy

Care of the Woman with Dysmenorrhea

Care of the Woman Undergoing Endometrial Biopsy

Care of the Woman with Endometriosis

Care Of the Woman with Fibroids

Care of the Woman with Gonorrhea

Care of the Woman with Hepatitis

Care of the Woman with Herpes Simplex

Care of the Woman with HIV( Human Immunodeficiency Virus )

Care of the Woman with Human Papillomavirus Infection

Care Of the Woman With Impaired Fertility

Care of the Woman with Nipple Discharge

Care of the Woman with Parasitic Infestation

Care of the Woman with Pelvic Inflammatory Disease.

Care of the Woman with Pelvic Pain..

Care Of the Woman with Polycystic Ovary Syndrome

Care of the Woman with Premenstrual Symptoms,

Syndrome, or Dysphoric Disorder

Care of the Woman with Syphilis

Care Of the Woman With Trichomoniasis

Care of the Woman with Vulvovaginal Candidiasis.

Web Resources for Clinicians