Clinical Practice Guideline for Type 2 Diabetes Mellitus

Type 2 Diabetes

            Today, Type 2 Diabetes Mellitus has emerged as one of the most serious and pervasive chronic health conditions plaguing developed nations such as Canada and the United States. According to the Centers for Disease Control and Prevention (CDC), Type 2 Diabetes Mellitus is currently considered a major public health concern in the United States given the fact that 1 in every 10 Americans suffers from the condition (AlSaraj, 2015). T2D is a heterogeneous disorder that develops among at-risk populations as a consequence of low production of insulin in the body. As a consequence, blood sugar levels rise to dangerous levels, further exposing sufferers to the risk of adverse clinical events such as cardiovascular disease (CVD) and autoimmune complications.

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 T2D is often associated with loss of proper working of the β-cell secretory function often associated with the accompanying resistance to insulin. Although T2D is a manageable condition, its clinical expression is often linked to patient’s failure to participate in a proper management program, in addition to a wide spectrum of genetic and environmental pre-disposing factors. T2D often manifests in the body’s inability to regulate how well it expends glucose while focusing primarily on its efficiency compared to healthy individuals (Lu, Anderson, & Huang, 2017). Type 2 Diabetes Mellitus commonly manifests during adulthood, but may also emerge among children predisposed by factors such as pre-term birth, obesity, family history, and further exacerbated by a sedentary lifestyle. The evolutionary origin of the condition is a malfunction in an obsolete genotype commonly associated with metabolic abnormalities such as hypertension and cardiovascular problems.

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            The subsequent malfunctioning of insulin β-cells forms the very basis of the pathophysiology of Type 2 Diabetes Mellitus. This is primarily due to the accompanying malfunctions which emerge as a consequence of transformed molecular pathways. Islets are, ultimately, unable to cope with the pressure which typically causes a high level of toxicity within this region. Individuals in this phase of disease progression will experience hyperglycemia as one of the initial signs of β-cell death and unregulated pro-insulin biosynthesis. The process forming the basis of the pathophysiology of T2D is, therefore, linked to a combination of physiological and environmental factors which hasten its rate of progression, causing both lipotoxicity and glucolipotoxicity (AlSaraj, 2015). Yet, healthcare experts recommend managing body mass, regular exercise, reducing sugar intake, smoking cessation, and avoiding a sedentary life as promising solutions to managing T2D.

Read also Pathophysiology of Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus Clinical Practice Guideline

            The management of T2D in the United States is guided by a set of elaborate clinical guidelines compiled and published by the American Diabetes Association (ADA) in the Standards of Medical Care in Diabetes. Its implementation seeks to ensure patients suffering from T2D remain in a state of remission after the initial diagnosis while comorbid health conditions are addressed, and appropriate standards for care are established. Furthermore, clinical practice guidelines addressing T2D seek to standardize management practices, provide elaborate guidelines on the identification of symptoms marking the onset of the condition, glycemic control recommendations, and the participation of patient’s family in the management of the condition.

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            Practice guidelines for T2D seek to address comorbid conditions such as hypertension and cardiovascular disease. Owing to the frequency of hypertension among diabetics, common practices now dictates that patients suffering from the condition consent to routine evaluation of their blood pressure level during routine clinical visits. In order to meet the minimum threshold for elevated blood pressure levels, readings should be above 140/90 mm Hg and also confirmed by a specialist after conducting several measurements (American Diabetes Association, 2019). In scenarios where patient readings indicate an elevated blood pressure level, voluntary admission is recommended and warranted to prevent a life-threatening event linked to pre-existing comorbid health conditions. The initial blood pressure measurement should then be followed by regular follow up sessions after setting respective targets for systolic and diastolic blood pressure levels. The execution of the aforementioned targets should also be accompanied by a clear weight loss regimen for obese patients, a regular exercise routine, and the consumption of a healthy balanced diet. Severe cases of hypertension among patients with T2D should be treated with a prescription of angiotensin-converting enzyme (ACE) inhibitors as a first-line pharmacological treatment option for the condition.

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            Medical care standards also form the basis of practice guidelines in the management of T2D. Pharmacological interventions should aspire to lower glucose levels while targeting a specified glycemic target.  Additionally, practice standards recommend patient education as a promising framework when seeking to reduce the number of individuals who ultimately develop the condition while mapping out pre-diabetics to address the risk of developing the conditions. This typically includes clinically obese children and adults yet to be diagnosed with the condition mainly since preliminary symptoms have not yet manifested.

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            Moreover, clinical practice standards for T2D now target early detection of the symptoms associated with condition, rather than focusing exclusively on the management of condition after its subsequent progression. Such efforts are geared towards the teens and young adults recently identified as a new frontier in the fight against T2D. Key elements to look out for include patient’s hepatic insulin resistance among overweight teens based on an appropriate screening method (Ndisang, Rastogi, & Vannacci, 2015). Factors which pre-dispose such individuals to developing the condition such as family history, gestational period, insulin resistance, and ethnicity should also be taken into account. Subjects should also adhere to a strict weight management program while making certain patients are fully cognizant of their current conditions and its implications. The provision of this information should also be done within cultural framework from which the patient is from to boost the odds of succeeding during the initial trial.

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            Hyperglycemia management also takes precedence in the proper management of T2D based on accepted clinical practices. Health care providers are expected to prioritize hyperglycemia management among patients with T2D due to its delicate nature and a high likelihood of disease progression within a relatively short period. Clinical staff should, therefore, direct their efforts towards patient education with the ultimate aim of ensuring patients are equipped with relevant resources and information to support self-management and self-monitoring. These efforts will then be bolstered by the application of pharmacological interventions such as sodium-glucose co-transporter-2 (SGL T2) to lower the glucose level present in the blood (Goldstein & Mueller-Wieland, 2016).  A balanced diet consisting of whole grains, fruits, and green vegetables is also recommended, in addition to metabolic surgery for morbidly obese patients unable to lose weight.

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            Within the United States, clinical guidelines for the management of T2D currently incorporate and acknowledge the family’s role and that of associated physicians in the management of T2D while averting adverse clinical events. Family and friends play an important role in the management of diabetes by ensuring patients meet set glycemic targets, body mass, and take medications as prescribed by their respective physicians (American Diabetes Association, 2019). The family is expected to play a central role in promoting appropriate management of the condition by ensuring patients commit to treatment, make lifestyle changes, and maintain up-to-date vaccines for a better glycemic control. This approach will also seek to reduce patient’s overall risk of succumbing to cardiovascular disease while aspiring for a healthy weight, practicing smoking cessation, taking vascular protective drugs, and avoiding a sedentary lifestyle.

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 Analysis

            The current healthcare environment within the United States is a source of concern for many healthcare pundits given the high likelihood of the general population being predisposed to developing T2D. This reality now prompts future reflections on how to address this problem appropriately given the rapid changes witnessed over the past decade. In my opinion, the Standards of Medical Care in Diabetes does an exceptional an exceptional job in providing practice guidelines for the management of T2D (American Diabetes Association, 2019). Yet, I hold the view that it still requires systematic improvements to address factors liked to demographic changes witnessed in the United States and emerging patient needs. The practice guidelines evaluated above should emphasize more on the importance of screening in suspected pre-diabetics to guarantee immediate attention to the condition while preventing disease progression. Physicians will also have a unique opportunity to categorize the condition appropriately devoid of distractions presented by comorbid conditions such as hypertension that are likely to mislead the initial diagnosis. This will then allow them to determine the exact stage in which a patient is in before deciding on the most appropriate intervention.

            In a scenario where I would be in a position to review the clinical guideline provided for T2D, I would focus more on tracking the progress of individual patients after starting treatment. The rationale behind my decision is informed by the relatively low progress rate recorded amongst patients with T2D. This is likely the result of a systematic failure by healthcare providers to fully evaluate patients after commencing treatment while applying data recorded during previous hospital visits to gauge progress. The introduction of this change in policy will also promote compliance with treatment plans and prescribed medications while also gauging their effectiveness in managing the condition. This would also guarantee the application of an individualized approach to the management of T2D among patients with the condition; enduring patient-specific issues linked to management of the condition addressed appropriately. During this period, physicians will also be expected to evaluate patient’s compliance to prescribed medications and determining whether incidences of non-compliance are associated with negative side effects (AlSaraj, 2015). Further lab tests will be conducted during the second visit to track progress and whether the metabolic targets have been attained as part of their management of the condition. Results of the implementation of these changes in the mode of operation will reduce the frequency of cardiovascular events and hypertension among patients with T2D. The reviewed segment of the clinical guideline should also contain evidence-based solutions on some of the most practical alternatives to preventing the condition and associated comorbidities. These solutions include a structured instructional guide on lifestyle management, drinking alcohol in moderation, consuming a healthy balanced diet, and smoking cessation. Patient education should also take precedence with the aim of emboldening patients to take direct charge of the management regimen while gaining a better understanding of the condition. The application of this structured approach will improve patient outcomes while boosting their confidence in self-care knowledge and nutrition therapy.

            The demographics in the United States have undergone wide-ranging transformation, with healthcare reform likely to have a major impact on T2D practice guidelines. Perhaps the most notable reasons for this change is the economic progress realized within the past decade and the likelihood the Department of Health and Human Services (HHS) focusing more on chronic health conditions such as T2D. Improved responses will also shape the direction taken by major healthcare agencies when attempting to curb the permeation of incurable yet manageable health condition. The implication of this new response will be in the enactment of healthcare policies which identify at-risk populations such as those residing in impoverished inner-city communities in an attempt to address factors predisposing them to chronic health conditions such as T2D.  It is also important to consider the possibility of an exponential increase in the population of morbidly obese individuals in the United States given the limited dissemination of crucial information associated with the prevention of T2D. According to Lukana (2019), close to 66% of the American population is represented by the middle-class likely to run the risk of developing chronic health conditions due to changes in lifestyle and an increase in incidences of individuals living a sedentary life. However, these same changes may also be beneficial to the healthcare system. Policymakers will become aware of some of these risks and work consistently to ensure pre-existing risks to developing T2D diabetes are addressed to reduce its prevalence within the US. Federal agencies in charge of healthcare will also partner with private players to address socio-economic barriers to care given transformation noted within the country.

            A number of useful frameworks can be enacted to increase the chances of the subsequent adoption of a new or revised clinical guideline to address T2D.  As a rule of thumb, EBP should inform any change made to the existing guidelines. This will ensure only properly-researched solutions are implemented by healthcare practitioners and dependable in the wake of numerous transformations present within the sector. Additionally, new guidelines should be practical and champion the collaboration of specialist from dissimilar fields but with the ultimate goal of introducing feasible solutions. Practice guidelines should also take the social context of their respective patients into account while basing their interventions on knowledge of patient’s needs. The application of pharmacological interventions should also be based solely on randomized clinical trials as practical guides to effective and highly dependable treatment options.

Evaluation

            The overall applicability of this revamped clinical practice guideline for patients with T2D can be gauged by assessing the subsequent impact of specified changes when attempting to manage the condition among target patients. An in-depth review of barriers to diabetic treatment adherence within the context of T2D would be an ideal starting point. This process should then be accompanied by efforts to identify feasible solutions to the problem through the implementation of an individualized framework when attempting ascertain the veracity of patient-specific concerns. Reacting to individual patients and their concerns will also promote efforts to shape the direction of new guidelines based on their efficiency when applying an iterative and elaborate framework.

Learning points

  • Type 2 Diabetes Mellitus is a serious chronic health condition with no cure and currently addressed through early intervention and adhering to a management framework based on clinical practice guidelines.
  • The American Diabetes Association (ADA) lists a multifaceted approach involving the use of prescribed medications and lifestyle modifications under the Standards of Medical Care in Diabetes as a practical solutionto managing Type 2 Diabetes Mellitus.
  • The paradigm shift witnessed within the context of demographics will also result in a higher life expectancy, a wealthier society, and the likelihood of an exponential increase in cases of Type 2 Diabetes Mellitus.

Decriminalize Prostitution – How to Deal with Prostitution

Decriminalize Prostitution

Decriminalization is the removal of all administrative and criminal penalties and prohibitions on sex work, including laws pursuing brothel owners and clients. Eliminating sex work criminal prosecution goes hand-in-hand with acknowledging sex work as work and safeguarding the sex workers’ rights via workplace safety and health standards. Decriminalizing sex work permits workers to access financial services such as insurance and bank accounts. It also implies that sex workers are most probable to live without fear of violence, social exclusion, and stigma.

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The Best Policy Position in General Terms – Decriminalize Prostitution

Prostitution decriminalization is the best policy position for prostitutes and society since it will protect prostitutes from violence and abuse. According to Freeman (2019), much of the abuse and violence experienced by sex workers is accredited to their being criminalized. Sex workers in the current system do not have the power to safeguard themselves from abuse and violence from clients. Many of them are unwilling to report sexual and physical violence since doing so would disclose their engagement in a criminalized activity. The stories of those who report are mostly dismissed, particularly in situations where police perceive sex workers as deserving of violence. All this would reduce when the activity is decriminalized.

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Decriminalization will also increase sex workers’ bargaining power and increase their chances of protecting themselves from sexually transmitted diseases. According to a study conducted by Lutnick and Cohan (2009), the criminalization of sex work increases fear of being arrested by the police. In this regard, most sex workers do not get a chance to have open negotiations with possible customers, like any other business. This would give them a chance to negotiate for all terms and to settle on agreed conditions. This will ensure that they operate in a more free business where they are not oppressed by their clients.

 Decriminalization will also help in improving their working condition to ensure health and safety. This will also enable them to organize and address problems facing their business such as sexually transmitted diseases. Sex workers can collectively address workplace risk factors by increasing access to condoms and other STD preventive measures. This can include enhancing access to financial and health services and setting rules that work to promote their safety and health. Sex workers criminalization create fear of negotiation process and visible condom due to making vulnerable to arrest. This discourages the use of condom and put them at high HIV risk. Decriminalization will change the situation, making it easy to negotiate and protect themselves (Refworld.org, n.d.).

 Contrary to the belief that decriminalization of prostitution will result in to increase in sex trafficking, jurisdictions that decriminalize prostitution can strengthen and retain criminal prohibition of sexual coercion, prostitution, and trafficking of minors. New Zealand for instance continues to be a position by the Department of States’ Trafficking in Person report by the U.S. in Tier 1 despite having decriminalized sex work in 2003. New Zealand is judged to be among the nations doing the most effective work in preventing human trafficking. Policies and laws that enable or encourage sex workers’ collectivization may also enhance anti-trafficking laws enforcement (Refworld.org, n.d).

The Policy Position the Would Advance the Case of Women’s Equality

Prostitution is only perceived as exploitive and objectifying in a situation where the client feels more superior to the woman offering the service. This is when men can treat sex workers brutally because they cannot complain to anyone about it, and if they complain they will be victimized for engaging in illegal business. Decriminalization of sex work will give sex workers higher bargaining power and ensure that prostitutes are treated better and under agreed business terms. It will also present prostitution as work with operation terms and conditions, bring decency to it. This will protect sex workers from prostitutes’ objectification (Blanchette, Da Silva & Camargo, 2021).

Decriminalization will also play a great role in eliminating prostitution stigma. Prostitutes experience stigma due to negative views of the practice in society. Most of these views are attributed to moral and legal perspectives. According to Mgbako et al. (2013), laws play an essential role in impacting societal attitudes. Criminalization of prostitution brands sex workers as criminals. This negatively influences how society perceives them. If sex workers are criminalized, society frequently believes that their abuse is justified. Consequently, they suffer abuse, discrimination, and stigma from many in the society including banks, police, schools, and health workers among other service providers. While it is hard to eliminate stigmatization due to moral perspective, decriminalization can reduce stigma by changing the community perspective and by helping in organizing the service better to ensure sex workers get good health care and financial services collectively. This will eliminate the need to go looking for doctors who will understand without judging. Decriminalization will also force police to help without having to dismiss sex workers as wishing it on themselves. The law will compel them to help since lack can result in litigation against them. This will at least reduce stigma among institutions sex workers are likely to depend on for help in case of anything.

The American constitution provides the right to liberty. This means women have the liberty to choose what to do with their bodies, as long as they are of the majority age. However, this is impossible with prostitution criminalization. Decriminalization will give women the liberty to choose to practice or not to practice prostitution without fear or coercion (Hrlc.org.au, 2012). The criminalization of prostitution does not prevent or stop the act, it only forces sex workers to conduct themselves in unsafe and unhealthy conditions. This means the perception of women is unlikely to change with the decriminalization of prostitution. Decriminalization will make the business and its area of practice well known such that it is easy to distinguish those who practice it from those who do not practice it. This means decriminalization will hardly ruin general women’s perception in society.

Poverty Inc by Michael Matheson Miller – Film Reaction Paper

Poverty Inc by Michael Matheson Miller

Poverty Inc . is a film that focuses on foreign aids and its effect on the economies of developing nations. According to the film, foreign aids are sent to struggling nations with intention of helping them. However, their situation does not change years after, or it has worsened. This means that other than helping them, offering foreign aids condemns people in developing nations to a lifetime of poverty, as it directly interferes with locals’ efforts to develop their economy, promotes laziness and wrong mentality.

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The film defines the global poverty industry that comprises governments, charities, NGOs, celebrities, multinational organizations or corporations, social entrepreneurs, and aid agencies. This industry focuses on helping the poor in developing nations. However, the current set up according to the film ends up benefiting those in the global poverty industry than the intended people. The film insinuates that this setup is deliberate since the complete elimination of poverty will set the global poverty industry out of business.

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A Reaction to the Film Poverty Inc by Michael Matheson Miller

Various incidences are illustrating how foreign aids propagate poverty in developing nations. The three selected incidences include rice aids in Haiti, the child adoption case in Haiti, and a high level of second-hand clothes in Kenya. The first incident illustrated in the film is the dumping of cheap rice in Haiti from the United States. Haiti was a rice-growing nation. Most farmers focused on rice farming as a form of economic empowerment. However, the U.S.A. aids brought free rice to Haitian people. This resulted in a lack of market for Haiti-grown rice. After the earthquake incident in 2010, rice importation from the United States did not stop.  The U.S. was imported at subsidized rates. This resulted in to increase in low price cost in the market, making it hard to sell local rice (YTminusTime 1). As a result, Haitian farmers stopped growing rice. This created a stop in their economic activity, creating unemployment and death in the rice farming in the country. Majority of farmers migrated to urban areas to look for jobs, increasing the number of slum dwellers, and the unemployed population. Instead of aids helping in fighting poverty, they interfered with individual economic growth and general economic wellbeing in the country. Although cheap rice resulted in low spending on food, it killed local agricultural industry slowing down the economy.  It also made farmers poorer by leaving them with nothing to do with their swampy land and without any source of income. It also interfered with the country’s economic growth. A country is said to experience economic growth by exporting more than importing. When a country imports what it can produce and maybe even export, then it creates a trade imbalance, making it poorer. 

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In the child adoption case, an American couple traveled to Haiti hoping to adopt a child. They later realized that there were so many kids who needed help, and hence they opted to create an orphanage. In their process of running the orphanage, they realized that majority of kids in the orphanage had one or both parents, who loved them and visited frequently. They were in an orphanage only to escape poverty and not to lack parental love. The couple realized that the adoption system involved children loved by parents but without means of survival (YTminusTime 1). They realized that those offering adoption for those kids were relieving parents from their parental duty and denying children parental love. This would result in broken families by the separation of kids from their parents who loved them. The availability of foster families made parents ready to neglect their duties and to give kids they loved away. This created a scenario where aids promote laziness and the wrong mentality of perceiving circumstantial poverty as a lifetime situation. Parents were ready to give children a way to escape poverty, rather than trying to figure out how to earn to raise them. Aids made them close their mind and take the easiest way out, resulting in a broken society, with a lost future.

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The increase in second-hand clothes in Kenya has resulted in the death of cotton farming and the textile industry in Kenya. Kenya experienced dumping with second-hand clothes that are way cheaper than the locally manufactured ones (YTminusTime 1). Consequently, there was an end of cotton farming in the country and a downsizing of the textile industry in the country. This resulted in job loss in cotton farming, leaving farmers jobless or with unprofitable agricultural products to grow due to climate and soil type. There was also job loss in the textile industry. The government also lost a source of taxation and a chance for experiencing industrialization in the country. All this promoted poverty in the country. People lost the desire to invest their skills, mind, and hope in the textile industry due to a lack of market for their products. The fear of dumping and the death of industry makes it hard for people to invest in the local industry, promoting a poverty mentality, and slow economic growth.

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Conclusion

The films gave a clear picture of the effect of excessive aids, especially where not needed. Rather than dumping finished goods in developing nations, the film advocate for improving people’s productivity in various areas. The film has made me realize how wrong I was about aids given in developing nations. Africa and other developing nations have enough natural resources to facilitate their growth. However, they lack the necessary support needed to exploit these resources for the economic good of their countries and themselves. However, developed nations deny them a chance to try or improve by bringing cheap or free products, destroying their market, promoting laziness and poverty mentality. The film has made change my mentality about aids. I have realized that aids are not always meant for helping the targeted party. With the global poverty industry, the provider of the aids seems to be benefiting more than those intended to receive the aids, and that is why they are not ready to stop. They are also not willing to bring aids that can aid in enhancing means of production. Normally, people become innovative when they have problems they must solve. Aids eliminate the need to solve any problem, making their receiver appear dump and without focus. Although it is okay to help during crises, those offering aids should know when to stop and give locals a chance to solve their problems. This is the only way they can grow.

Criminal Justice Policing Awareness Report – North Providence Police Department

Imagine you have been asked to provide information to your community at a town hall meeting about the functions of your local police department. You have been asked to provide a Policing Awareness Report handout to the people who attend.

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Consider the research on the following items:

  • The impact of policing in your community
  • Community programs offered by the police
  • Theories of criminal behavior that most align with the goals and programs of police in your community

Write a report to provide to the townhall meeting attendees in which you explain your findings with the following sections to answer the following:

Mission:

1. What is the mission of your local police department?

Goals:

2. What goals does your local police department have? How do they work to accomplish these goals?

Community:

  1. What are the various roles police play in your community? What is their impact?
  2. How do your local police partner with citizens and other entities?
  3. What community programs (e.g., D.A.R.E., Police Explorers) are offered by your local police department?
  4. Explain the programs, including the benefits they provide to society and the role the police play in these programs.

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Policing Awareness Report Overview

Over the past decade, relations between law enforcement agencies and the general public have become a major focal point within the United States. These relations are at an all-time low across the nation; with many expressing their distrust for the police and whether they are actually serving and protecting the communities they frequently patrol. Calls for accountability within law enforcement agencies now occupy the national debate with many lobby groups blatantly claiming that police officers have largely failed to discharge their duties diligently (McGuire et al., 2021). The sharp rise in officer-involved shootings of racial minorities is now a major area of concern for activists who now call for a complete overhaul of law enforcement agencies in the United States. Incidences such as the slaying of unarmed individuals, such as George Floyd and Briana Taylor, have reignited the debate on police brutality and the inaction of state and federal agencies. It is for this very reason that groups such as the Black Lives Matter (BLM) movement have called for a thorough policing of law enforcement agencies and even gone as far as making controversial suggestions such as de-funding police precincts.

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In light of the recent realities in police-community relations, it is worth noting that the North Providence Police Department (NPPD) has remained dedicated to upholding the basic tenets of policing within our community. The North Providence Police Department has , time and again, made it abundantly clear that their sole responsibility is to maintain law and order within the entire Providence region while guaranteeing individuals of their personal safety. However, the department also acknowledges that it also has to express a tough stance against sporadic crimes witnessed within the area and to deal with offenders within the confines of the law. The recent spate of armed robberies, home-invasions, smash-and-grab burglaries, and homicides are a clear indication of the challenges the department is up against hence the need to support the department during this difficult period. Officers from the North Providence Police Department currently serve between 33,000 and 34, 000 residents residing within the Providence region and its environs (North Providence Police Department, 2021). Although the officers are thinly stretched throughout this extensive swathe of territory, they remain committed to offering much-needed law enforcement services and maintaining order. The NPPD is also a notable pioneer of community policing which it considers a necessary strategy when attempting to cultivate trust and accountability with the local population.

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Mission of Policing Awareness

The primary mission of the North Providence Police Department is to improve relations with the local communities to pave the way for community policing in the long run. Department chiefs now realize that the solution to crime, especially in inner-city, is implementing a rigorous community-policing strategy designed to curb antisocial behavior among vulnerable members of society. This strategy should also involve developing a deep inter-personal relationship with community leaders able to alert the police about suspicious activities within their areas while establishing possible mitigation strategies designed to curb insecurity. Moreover, the department also seeks to ensure that community policing is designated as a mainstream policing strategy within the Providence region and also taught in the police academy. This is meant to ensure that rookie officers are immediately conscious of their role in serving the community while developing relationships based on respect and trust. Besides, the North Providence Police Department’s mission also encompasses the provision of high-quality policing services and a timely response to any reports filed by complainants (North Providence Police Department, 2021). This will only be achieved by focusing exclusively on personal excellence in policing and espousing personal responsibility among law enforcement officers.

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Goals of Policing Awareness

The main goal of policing awareness is building public trust to guarantee that the community will develop total trust in the local police department. This process should always begin with law enforcement agencies reiterating that their sole objective is to serve the people rather than police. Departments that are able to form a rapport with the local communities often reap the benefits of this relationship; evident in an overall reduction in spates of crime while boosting public trust in law enforcement agencies. Additionally, policing awareness by the North Providence Police Department also seeks to promote professionalism among its officers to ensure that their conduct remains within the law. This often involves capacity building programs designed with the main aim of ensuring that officers are fully aware of all critical tenets of the US Constitution and are able to implement them while respecting people’s individual rights (Ling, 2015). This fits perfectly in the department’s goal of maintaining public safety while upholding individual’s personal rights , inclusive of the protection of life and property. This goal can only be achieved through an exclusive focus on developing workable collaborative programs to blur the purported divide between the public and law enforcement officials.

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Role of the Community in Policing Awareness

Today, the North Providence Police Department realizes the sheer importance of improving relations with local communities as a basic solution to some of the problems plaguing the department. Officers from the department now recognize their individual impact in transforming the tide of negative relations between law enforcement agencies and local communities (Fielding, 2015).One of the most highly-recommended strategies has often involved the regular patrolling of major crime-ridden areas while also attempting to develop a symbiotic relationship with the public. Additionally, the department recently created a highly trained crisis management team to address any emerging challenges stemming from police interactions with the public. This program was specifically designed to cultivate public confidence in the police while also ensuring that individual officers are always held to account. The “Coffee with a Cop” program is also among one of the most successful community policing initiatives now designed to improve relations between law enforcement officers and the public.

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The ultimate success of the North Providence Police Department also relies heavily on its emphasis on the actual importance of intra- and inter-departmental collaboration across precincts located in different regions across the US. This strategy is designed to serve as a useful conduit for the dissemination of critical information on police-community relations and some of the most viable solutions to employ when aspiring for long-term success. Moreover, this process also includes the integration of programs designed to involve community leaders in the decision-making process while ensuring that individual feedback is always considered. High-level cooperation initiatives, such as partnering with local, state, and federal law enforcement agencies also creates a unique opportunity for brainstorming on how to improve police relations with citizens. Security-based information can always be shared within such forums which always goes a long way in improving the operational capability of strategies such as “Code Watch and Community Watch”.

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The involvement of law enforcement agencies in policing awareness strategies is also essential when attempting to lessen the divide currently present between the police and law enforcement agencies. Bridging this gap, through notable initiatives such as “Coffee with a Cop” and “Code Watch and Community Watch”, fosters a great deal of trust in the capacity and dedication of law enforcement agencies and is bound to eventually go a long way in improving damaged relations. Such forums also provide a unique platform for conducting theft awareness initiatives, the integration of mediation in solving local disputes within the community, and the identification and documenting of serial repeat offenders.

Applying Critical Thinking in the Workplace Environment

The contemporary workplace environment is a complex and dynamic area of functioning guided by a strict code of conduct and basic standards developed over time to promote efficiency and productivity. From time to time, supervisors, front-line managers, and upper management are tasked with identifying novel organizational strategies likely to elevate the subjective experience of staff while also ensuring they meet set organizational objectives. Critical thinking is one such idea that has recently been championed by managers and organizational teams as one of the most relevant competences to possess in today’s fast-paced global business environment (Elder, 2022). The rationale behind the formal adoption of critical thinking skills within the modern-day workplace environment is that organizational staff should always be afforded a certain degree of autonomy within an individual occupational capacity.

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Critical thinking often entails having the ability to isolate individual work-place scenarios requiring immediate attention, identifying a feasible solution to this problem, and being able to make the right decision when faced with an ethical dilemma. According to Hester (2021), organizations should always strive to foster and nurture critical thinking skills among their employees as one of the most reliable techniques when seeking to bolster both intellectual and organizational development. Developing an organizational culture centered on the application of critical thinking skills within the workplace environment is now hailed as a revolution in capacity building. The application of critical thinking skills, therefore, plays a major role in the subsequent creation of a workplace environment where staff are provided with an opportunity for career advancement through the streamlining of personal goals with organizational objectives.

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Elements of Critical Thinking Required in the Workplace Environment

Growth and organizational progress is a methodical process known to rely heavily on shrewd leadership and the ability to identify the most beneficial policies to implement within the workplace environment. Critical think has often been described as a complex assemblage of logical perspective and positions designed to guide professionals in making informed decisions in a difficult situation. It typically encompasses the ability to make spontaneous rational decisions based on specified organizational culture and, therefore, serves as a crucial foundation for developing a practical plan of action. Management teams are usually at the forefront of establishing organizational standards to be observed by staff across each organizational level to promote uniformity. This particular aptitude is normally developed through rigorous training through refresher courses based on capacity building and the eventually creation of a logical reference point for application. Management teams are, thus, obligated to ensure that participants gain a rich understanding of all basic elements of critical thinking as a crucial starting point during such endeavors.

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Moreover, this process also includes acknowledging some of the main barriers to efficiency and realization of critical thinking within the workplace environment to ensure staff are equipped with solutions to such problems in the foreseeable future. Resistance to change and work-related stress have often been cited as some of the most common barriers to critical thinking among staff operating within high-pressure business environments. Countering these two elements through employee education and the proper identification of possible contingency measures may be the difference between success and failure in an organization. Employees who happen to experience a high level of work-related stress are often associated with the irrational decision-making skills and an overall inability to satisfy key performance indicator (KPIs). They are prone to agitation and emotional outbursts out of sheer frustration and the inability to satisfy basic organizational requirements. Management teams are, therefore, required to be particularly mindful of the basic dissemination of elements of critical thinking to staff to avoid unwarranted confrontations with staff while promoting collective consensus in the workplace environment.

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Relevance of Reason, Emotion, and Community in Critical Thinking

At the present moment, reason, emotion, and communication play a fundamental role as the basic tenets of critical thinking within the context of the workplace environment. Management teams, front-line managers, and supervisors often expect staff to exercise an elite level of critical appraisal during different scenarios with the expectation that they are fully capable of exercising reason during high-pressure scenarios. The capacity to reason sets employees apart from any possible rivals and is typically encouraged as one of the ways of ensuring a company always has a competitive advantage over contemporaries operating in a similar sector (Dirkx, 2017). The ability to reason widens the basic scope of possibilities for an organization given that individuals with this aptitude are able to evaluate the benefits and implications of organizational decisions based on existing facts and operational standards. Any inadequacies in the system, such as a potentially faulty warranty policy, are painstakingly evaluated based solely on established facts and empirical evidence gathered over an extended period of time.

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The integration of evidence-based strategies frequently creates scenarios where any potential technical inadequacy is subjected to a thorough practical evaluation to establish possible malfunctions and the subsequent identification of feasible solutions. Besides, reason is also bolstered by an individual’s emotional intelligence and their ability to apply within the archetypal critical thinking scenario. It involves taking into account the ideas and perspectives of other team members and debating them respectfully to arrive at a consensus. Emotional intelligence also entails being acutely aware of individual’s mental state at any given to promote a sense of congruence while preventing the overlap of ideas. The ultimate inclusion of communication as a crucial element of critical thinking also ensures that any emerging conflict is solved through dialogue based on existing interpersonal relationships. This often entails avoiding aggressive posturing during communication as one of the most practical solutions when seeking to avoid direct confrontations known to foment resentment and conflict within a team.

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Fallacies and Argument in Critical Thinking

The modern-day workplace environment is frequently plagued prejudgments and wrongful assumptions made by employees based on subjective experiences. Team members who happen to acknowledge the actual influence of fallacies and arguments within the context of critical thinking stand a better chance of making remarkable contributions to the organization due to this type of elite reevaluation. Today, ad hominem fallacies feature prominently within the contemporary workplace environment and are said to have a major impact on the arguments voiced by team members and decisions made during a particularly taxing situation. Although team members may voice their claims and conclusions based solely on available evidence, their argument may end up being rejected based solely on warped assumptions made by others within this operational framework. Dismissed arguments should, therefore, be subjected to re-evaluations, by other members of the management team to determine whether they were warranted or employed as a personal attack.

Conclusion

Critical thinking is, perhaps, one of the most highly acclaimed aptitudes in the modern-day workplace environment. It is specifically designed to ensure team members are able to make practical decisions in the face of challenging circumstances and are eventually able to bolster the decision-making process with fact-based assumption. Full acknowledgment of the influence of the basic elements of critical thinking in the decision-making process is also necessary to attempting to promote practicality at work. The role of resistance, work-related stress, reason, emotion, and communication should also be routinely evaluated by a relevant management team. This opens the door to discussions on the potential effects of fallacies and arguments during the decision-making process and the influence of able leadership in resolving any such problem.

Jeffery Dahmer: A 2022 Psychoanalysis of a Serial Killer

The Netflix series Dahmer: Monster: The Jeffrey Dahmer Story had 856.2 million hours watched 28 days after its release. All those hours are evidence of the intrigue around Jeffry Dahmer, one of the most infamous serial killers from the United States. People have described his demeanor as calm and non-threatening on social media. 

It then begs the question – what would flip his psychological switch and lead him to commit such heinous atrocities?

What is psychological analysis?

Psychological analysis is a science originated by scientist Sigmund Freud. A psychological analysis of behavior studies free association, unconscious impulses, anxieties, and internal conflicts. Its main objective is to study the mind and the unconscious mind to achieve an understanding and effective treatment of mental disorders.

To psychologically analyze Jeffry Dahmer, the best place to start is his background and history.

Who is Jeffry Dahmer?

Jeffrey Lionel Dahmer was a sex offender and serial killer born in May 1960 in Milwaukee, Wisconsin. Dahmer was the firstborn child of Lionel Dahmer, a research chemist, and Joyce Annette, a teleprinter operator instructor. 

Jeffrey Dahmer became famous for serial killings, sexual offenses, cannibalism, and necrophilia crimes he committed from 1978 until his apprehension on 22nd July 1991. His crimes earned him the monikers; The Milwaukee Cannibal and The Milwaukee Monster.

He was born while his father was still a university student, which limited the amount of time Lionel spent with his young family. At the time, his mother was young, craved attention, suffered depression, and was reportedly a hypochondriac. Joyce attempted to overdose on Equanil, a medication used to treat anxiety. In an interview, Dahmer said he recalls doubting the solidity of his family.

Despite those dark spots, he was shown affection by his parents. Sources close to the family claim his parents showed an utmost fondness for young Dahmer. Many people can relate to such a situation where parents are busy building careers and discovering themselves. Some are too busy and occupied to be consistently available for their children.

How did Jeffrey Dahmer become a serial killer?

Like many children, Dahmer maintained a happy aura during his early years. However, he became silent and fearful after he underwent a double hernia surgery when he was three years old. During an interview, his father said as Dahmer grew, he developed an affinity for animal bones.

Dahmer then began collecting insects and skeletons of small animals such as squirrels. He was then interested in bleaching animal bones and preserving remains of dead animals with formaldehyde which his father obliged as he thought his son was developing an interest in science and specifically Chemistry like his dad.

During his high school days, Dahmer was persona non grata or an outcast. He found solace in alcohol and even referred to it as his medicine to classmates at 14. Even as a teenager, he was articulate in speech, polite, and very intelligent despite not reflecting on his grades.

Dahmer said he began fantasizing and obsessing about killing when he was about 15 and 16 years old. He described feeling sexual desires and wanting to possess power and control over other men. These feelings continued to evolve and led to Dahmer luring and sexually abusing, murdering, and dismembering 17 young men.

His first murder happened just after graduating from high school. He killed hitchhiker Steven Hicks who he lured to his house by offering beer. Dahmer had the intention of sleeping with Hicks. Fearing rejection and Hicks intending to leave after they were drunk, Dahmer struck him repeatedly with a dumbbell and then used its bar to choke him to death. Dahmer then describes pleasuring himself while standing over his lifeless body.

Alcoholic Dependency and Personality Change

Drinking at an early age morphed into alcohol dependency as he grew older. This dependency contributed to dropping out of college months after admission. He had recorded low grades in Introduction to Anthropology and Administrative Science.

After dropping out, his father encouraged him to enlist in the army, which he did. During his military service, he would get apprehended often for being drunk. He progressed and served as a medic after being deployed to West Germany. He performed well until his performance dropped due to regular intoxication. He would later get discharged as he could no longer effectively undertake his duties.

Back at home, his sexual fantasies, alcohol dependency, and tendencies advanced and eventually got him arrested for indecent exposure, his first arrest.

Another instance when he was in trouble with the law is when his neighbors called the police after they noticed a young boy naked and bleeding just outside his house. The police returned the boy to his residence. Dahmer is heard on record calmly explaining they were lovers and had just had a quarrel, a claim the police believed. The young boy, Konerak Sinthasomphone, was one of the serial 17 victims.

In an interview aired in February 1993 by Inside Edition, Dahmer said when his family moved to Milwaukee in 1981, he discovered and started reading pornography. He would then frequent gay bars and use his allure and manipulation to convince men to go home with him. He describes only wanting to drug and sleep with them while unconscious but sometimes would wake up having hurt his victims without any recollection of doing it.

On one occasion, Dahmer remembers waking up next to a man he had beaten while in a stupor. He then killed him and carried the body out of the motel they were in using a suitcase. Dahmer then dismembered the body and dumped it using plastic garbage bags.

During media interviews after his capture, he described watching The Exorcist III movie as a ritual before committing his egregious crimes. He also says he desired to build and dedicate to himself an altar where he could keep parts of his victims as memorabilia. At times Dahmer took photos of his dead victims. Other times he kept body parts like skulls and other bones.

Psychoanalysis of Jeffery Dahmer the Serial Killer

A serial killer is a murderer who seeks psychological gratification by killing more than three people over a month or more. Murders committed by serial killers are usually premeditated and are associated with sexual offenses.

During his trial, Jeffery Dahmer had a psyche examination done by a forensic psychiatrist. He was diagnosed with psychotic disorder, borderline personality disorder, and alcohol dependency. The psychiatrist also determined that Dahmer was legally sane. The examinations were vital as they were a factor in his sentencing. Dahmer was handed a sentence of 941 years without the possibility of parole for 16 murders of the 17 murders he committed.

People diagnosed with borderline personality disorder may exhibit the following symptoms; mood swings, anxiety, delusion, suicidal thoughts, a distorted self-image, comfortable in isolation, and lack of interest in routine activities. During media interviews, he describes having these symptoms from an early age.

Symptoms of the psychotic disorder include; hallucinations, emotional detachment from family and friends, paranoia, timid behavior, diversion from topics during conversations, and irregular sleeping patterns.

Causes of the above disorders vary depending on an individual and their environment. However, drug and alcohol abuse, a history of domestic violence, emotional abuse, and neglect are risk factors for the conditions.

The Milwaukee Cannibal experienced some of the above risk factors. His constant intoxication and self-isolation during his upbringing could have been a factor as to why he became a serial killer. 

What dumbfounds people is how he killed 17 people in gruesome ways for all those years without getting caught.

His ability to evade capture from authorities and conceal his nature from his family and the public can be due to various factors. Dahmer was a white male, had a calm demeanor, was articulate in his speech, and it was accepted and known he kept to himself. Dahmer also targeted victims who would be hard to notice were missing.

Evading the Law his Murderous Behavior

His killing spree was between 1978 and 1991, a dark period for men from the gay community. Many were outcasts, were rebuked by their families, and hence would lose contact after running away. There was also no social media which made contact between his victims and people they knew difficult. Such victims were easy targets for Dahmer as no one would report them missing.

In the 1993 interview, Dahmer does admit being aware of his actions. He also claimed he felt remorse and guilt for his actions. His ability to manipulate and convince victims could be a trait due to borderline personality disorder. His psychotic disorder explains his inability to stop himself from going through with his heinous actions. He stated that although he knew his actions were wrong, he couldn’t inhibit his compulsive urges.

Upon his apprehension in 1991, Dahmer waived his right to a lawyer. He wanted to confess to all his murders and stated that it was a relief that he finally got caught. According to him, if he wasn’t apprehended, he might have continued with the murders.

During all his interviews and court hearings, he stayed calm and collected. He described in detail his sexual crimes, cannibalism, murders, and necrophilia. His physical appearance and demeanor amazed many people as he told of his actions as it seemed like he was explaining a recipe.

Dahmer’s story demonstrates the importance of treating mental conditions early. People deemed normal by society can be serial killers and offenders and commit these crimes for a long time without people noticing. 

Increase in Family Violence During the COVID-19 Pandemic

Covid-19 Pandemic and Family Violence

Countries across the globe are battling COVID-19 by employing measures that include school closures, national quarantines, online work, lockdown, and border closures to minimize the transmission speed. Almost every region in the world has experienced some kind of restriction, with measures differing from one area to another. For instance, United States enacted regional lockdowns, while countries such as Italy enacted indefinite total lockdown. The situation worsened as the number of infected people increased worldwide. Other than the increase in the rate of infection, COVID-19 has impacted societies, relationships, and families in unpredictable and unimaginable ways resulting in socioeconomic crisis. COVID-19 is subjecting societies to pressure that goes past social care systems, political leadership, international solidarity, and healthcare infrastructure. One such weighty impact that is currently being experienced at an alarming rate is the effects of increasing cases of domestic or family violence during the pandemic (Sharma and Borah 2).

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Domestic and family violence is one of the common social problems in our society. Domestic and family health violence are approximated to impact 10 million individuals in the United States annually. It is a public health issue and nearly all healthcare professionals will treat or evaluate a family or domestic violence patient at some point. Family and domestic violence define a wide range of abuse that includes psychological, economic, emotional, physical, and sexual abuse toward elders, adults, and children (Huecker et al. 1).

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Family violence has been a serious social problem in our society for a long time. However, the situation is said to have been worsened by the COVID-19 pandemic. The rates of violence against women are currently on the rise and are a major concern during the COVID-19 pandemic globally. According to Sharma and Borah (2), a recent article from The Guardian documents a surge in domestic violence and stresses on a pattern that can be observed worldwide. According to the report, Brazil experience a rise in domestic violence incidences by 40-50% during the pandemic. The UK experienced an increase in calls associated with domestic violence cases by 25% in a week after lockdown and strict social distancing measures were executed (Sharma and Borah 2).

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In the USA, there was a spike in domestic violence cases during the Pandemic in various states. Portland, for instance, experiences a spike in cases of arrest associated with domestic violence by 22%, there was a 27% increase in cases of domestic violence calls in Jefferson Country Alabama in March 2020 compared to the same time in 2019. New York City also experienced an increase in domestic violence helpline calls by 10% in March 2020 compared to the same time in 2019 (Sharma and Borah 2). Cyprus and Spain experience a spike in helplines call by 20-30% in the first few days of lockdown and also in a week after the report of the first case of COVID-19 in the countries. France also recorded an increase in domestic violence by 30% since March 2020, with Paris alone recording a 36% increase in domestic violence (Nittari et al. 5).

A study by the Center for Global Development on violence against children and women during COVID-19 revealed a general increase in children and women violence across the globe. Jordan documented quadrupling of self-reported violence against women. Also, China demonstrated a 278% increase in police calls for domestic violence during the pandemic. The study also recorded an increase in domestic violence in Bangladesh, Iran, Nigeria, Germany, Chile, Colombia, Italy, Mexico, Hubei, Iran, Isfahan, Thailand, Indonesia, India, and Malaysia among others (Bourgault et al. 2-3).

Why did Family Violence Increase During the Covid-19 Pandemic?

The increase of family violence during the pandemic is highly blamed on policies and regulations employed by most countries to control the spread of the disease. Most countries employed COVID-19 containment measures that included lockdowns, quarantines, and social distancing have resulted in social isolation, movement restriction, and economic insecurity. This increased domestic violence risk factors. Victims were quarantined with abusive partners, reducing or eliminating the safe window they used to have before the pandemic. Lockdown has offered greater freedom to abusers. It has made it easier for an abuser to enact control tactics by reducing the victim’s access to the internet, phones, and other people.

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Moreover, victims were disconnected from their normal support systems such as community, friends, and family, with the consequent increase in difficulties in seeking help. Moreover, it has been postulated that isolation paired with economic psychological stressors such as limited social support, unemployment, limited resources, and reduced income, that accompany the pandemic and resulting in a possible increase in negative coping strategies such as binge drinking, can integrate to create a perfect storm to ignite violent behaviors in the family (Mittal and Singh 4). 

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Despite the recorded increase in domestic violence during a pandemic, some studies have identified a realized increase in unreported gender-based violence cases during the pandemic. According to Mittal and Singh (4), most of the employed policies put in place to address the COVID-19 pandemic made it hard for some of the victims to report cases of family violence. Several gender-based violent shelters and NGOs experienced a decline in helpline number calls during the pandemic. This includes Jagori, a Delhi-based NGO that experience a 50% drop in helpline calls. A similar situation was experienced in Norwegian shelters for domestic violence victims. This was blamed on abusers’ freedom to control victims, and lack of collaboration among the involved agents in addressing family violence, mostly due to lockdown and other measures (Bergman et al. 1).

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To address the issue of increasing family violence during the pandemic, the involved agencies should focus on ignored measures during a pandemic. The agents should find a way to expand community partnerships and collaboration and creating awareness. They should also find better reporting methods that are unlikely to alert the abuser. For instance, rather than using phone calls, they can consider using SMS, WhatsApp chats, emails, Tweets, or Facebook chats. The involved authority should also facilitate the provision of counseling, and other therapeutic intervention using telephones or the internets, especially among individuals going through psychological problems or experiencing other stressors that can initiate negative coping techniques. Addressing psychological issues before they escalate would help in reducing the increase in violence.

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The research has highly enlightened me on increase in the cases of family violence during the pandemic. Before the research, I expected that most people living with abusive partners were likely to experience an increase in abuse frequency, due to lockdown and lack of safe space. However, the rate of increase in reported domestic violence cases made me realize that the pandemic created a new set of abusers, as a result of economic and social stressors. This means there have been a huge number of couples experiencing abuse for the first time. This shows the magnitude of the COVID-19 crisis on people’s lives, especially due to its effect on people’s economic and social wellbeing.

U.S. Drug Prices, Why Are they so High?

Drug Prices in The United States

Nearly one in four Americans who take prescription drugs say they struggle to afford the medication they need. A recent report from RAND Corporation found that US prescription drug prices are 256% higher than other countries; averaging the prices seen in 32 other countries (Light & Caplan, 2018). The ratio of sales to volume weight is significantly higher in the US. Zolgensma, a drug that treats spinal muscular atrophy, is the most expensive drug in the U.S. It has an estimated annual cost of $2,125,000. Unbranded generics account for approximately 12% of prescription drug spending at manufacturer prices (Walker, 2015). The branded drugs make up 11% of the US prescription volume and 82% of expenditure. Therefore, brand drugs are the primary driver of the higher prescription drug prices in the country. These prices, in fact, have been exponentially increasing for a while.

Why Are Drug Prices so High In United States?

The simple explanation of this excessive drug prices is monopoly pricing. By using the patent protection and FDA marketing exclusivity, the government gives pharmaceutical companies a monopoly on brand-name drugs. Monopolies are the highest risk factors for excessive prices.

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It is very difficult to note the actual out-of-pocket cost to consumers for a prescription because of the consumer rebates and price adjustments to insurers. Thus, the true cost of these prescription drugs is difficult to determine (Berman & Thomas, 2017). These prices are engrossed in a web of price adjustments and middle managers from the gross price to the actual price that the consumer pays. Patients’ out-of-pocket costs continue to grow while net costs to insurers keep declining, meaning that the insured patients are bearing a disproportionate share of the costs relative to the terms of their insurance agreements (Bollyky & Kesselheim, 2017). Clearly, the health insurance system in the US is so unique to any other developed country.

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Another reason for the higher prices in the country is because the government does not set ceiling prices in the US as other countries do. Also, there are marketing exclusivity periods for patented innovator drugs. There is a group of middlemen known as Pharmacy Benefit Managers (PBMs) that negotiates prices with pharmaceutical companies for inclusivity of health insurance coverage lists (Berman & Thomas, 2017). These groups often promote implementation of direct discounts or rebates that lead to higher prices to the consumer. This results in a war of internal pricing where manufactures are given incentives to increase list prices while increasing discounts to keep PBMs happy.

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Has The Government Done Anything To Lower Drug Prices?

In mid Sep 2020, the Trump administration signed an executive order to lower prescription drugs by “putting America first.” A Most Favored Nation strategy to drug pricing creates a trading opportunity among states making originally bilateral agreements multilateral (Bollyky & Kesselheim, 2017). The implication of this is that the drugs covered under the most favored nation pricing scheme will be expanded. This initiative will allow Medicare to use the lower prices of the other developed countries than paying higher for the same drugs.  Also, Trump announced the end of the Unapproved Drugs Initiative program that was responsible for major shortages of vital medicines (Light & Caplan, 2018).

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This implies that the drug prices may be five times less expensive than before if the Biden administration implements this policy. The true cost of a drug depends on who’s paying, and everyone involved is pushing costs up. There should be fundamental rebate reforms to fix both the cost-shifting problems in the US and develop a more open and reliable net price. Medicare should be allowed to negotiate drug prices in order to help drive costs down and end the monopoly in pricing. Also, it is important for every citizen to have health coverage to benefit from negotiated pricing.

Conjunctivital Injection, Its Pathophysiology, Causes and Diagnosis

What is Conjunctivital Injection (Hyperemia)

Conjunctivital injection is a nonspecific response of the human body characterized by adjustment of blood volume to support tissues located in various body system. The condition results in a marked enlargement of the conjunctival vessels; causing localized irritation, redness, and inflammation along the affected regions. Binary scales, such as the McMonnies/Chapman-Davies scale (MC-D), are a common reference point for healthcare providers assessing patients with suspected cases of CI, especially given that they are able to compare the redness in patient’s eyes with a collage of relevant reference images. The initial review of patients is fundamental methodical process which aids healthcare providers in determining the severity of Conjunctivital injection infection in patients in addition to intra- and inter-observable variations present.

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The Pathophysiology of Conjunctivital Injection

The pathophysiology of CI can be tracked from a single sophisticated internal process where blood flow is adjusted in immediate response to pressing metabolic needs in the body. This eventually results in micro-circulation and local vasodilation in which the various blood vessels seek to actively compensate for a sudden oxygen debt during a period of intense physical activity. Moreover, vasodilation in cases of CI may occur as a response to trauma or the presence of microbial infection known to cause inflammation. It is primarily controlled by the sympathetic brain system and acts in response to drastic changes impairing normal function within the endothelial cells (Beckmann et al., 2015).

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Immediate medical attention is recommended in such scenarios since micro-circulation constitutes a medical emergency given that it predisposes patients to ischemic organ damage, severe sepsis, and multi-organ failure. The active engorgement of blood vessels in cases of CI is also a common feature associated with the condition, especially since the body tries to restore optimal blood pressure within vascular beds located in various body systems. CI eventually causes a dangerous elevation of vascular CO2 concentration and other existing blood metabolites which acts as a localized stimulus for active vasodilation. It is also important to note that CI is the foremost most reliable sign of dangerous vascular changes taking place within the body in direct response to infections caused by a foreign microbial colony or an inflammatory stimulus. The eventual result is the severe reddening of the hyperemic vessels due to vascular engorgement as indicated in the McMonnies/Chapman-Davies scale (MC-D) diagnostic criterion.

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Causes and Prevention of Conjunctivital Injection

Causes

Cases of Conjunctivital Injection, either active or passive, normally as part of a healthy physical response to uncharacteristic changes in blood pressure. These changes may be of a physiological origin or caused by disease or distress. The following are some of the most common causes of changes in blood pressure known to cause Conjunctivital injection:

  1. Intense physical exertion while exercising resulting in a cardiovascular response to compensate for more blood and oxygen.
  2. CI can also be caused by physical trauma or infection, where the outflow of blood assists in self-repair.
  3. Changes in the internal body temperature, especially when experiencing fever can also cause CI during the body’s attempt to release internal heat through the skin.
  4. Frequent hormonal changes, such as those witnessed during the pre- and postmenopausal phases in women, often cause hot flashes likely to trigger CI.
  5. Extended periods of inactivity among persons with a sedentary lifestyle may cause vascular blockages due to the excessive buildup of blood prompting a cardiovascular response to adjust changes in vascular blood volume.

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Prevention

The prevention of Conjunctivital injection today should always begin with preventative and community health awareness initiatives to improve the general public’s understanding of the condition and existing steps to prevent it. This process would entail making sure each individual is aware of CI as a singular event where changes in blood pressure trigger a response in the body in an attempt to obtain much-needed nutrients and oxygen. It would then be accompanied by outlining some of the conditions predisposing individuals to developing CI, either passive or active, and how to prevent such an eventuality (Brunt et al., 2011). CI can be averted by making major lifestyle changes, such a avoiding a sedentary lifestyle and engaging in frequent light to moderate physical exercise. Moreover, the condition can also be prevented by proper weight management and eating a heart-healthy diet.

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Diagnosis-Symptoms and Treatment

Symptoms Associated with Conjunctivital Injection

A thorough examination of patient’s presenting with suspected cases of CI based on existing diagnostic criterion is necessary when seeking to promote individual welfare while improving healthcare outcomes. The clinical evaluation will, therefore, involve an assessment of the most common CI symptoms based on chromaticity, the tortuosity of blood vessels located within the region of interest, and the morphology of blood vessels (Bernstein, 2019). Symptomatic signs of CI may include reports of trouble breathing, severe chest pain (angina), and unexplained body aches. Other prominent symptoms associated with CI include coughing, swelling of lower limbs, and itching across the body. Each of the symptoms discussed above are, therefore, meant to guide physicians in diagnosing suspected cases of CI, prior to the mandatory imaging, exercise-stress, and blood tests.

Recommended Treatments

The primary objective of immediate commencement with available CI therapy options is to alleviate patient’s presenting symptoms in order to afford them some level of relief. However, it is important to note that treatment for CI does not focus exclusively on the condition given that it is often a sign of an underlying health problem. Medical attention and treatment is normally recommended in cases of active CI since blood flow cannot flow autonomously, allowing the body to lower elevated internal temperature (Tamura et al., 2015). CI treatment normally incorporates a combination of dietary changes and major lifestyle changes. The dietary involved in within a treatment context involves subscribing to a strict dietary regimen incorporating heart-healthy food options. Patients will also be expected to submit to a thorough and consistent weight management routine in order to maintain a healthy body mass. Pharmacological interventions are often prescribed as a last option and may involve administering beta-blockers and ACE inhibitors for cardiovascular support and the lowering of blood pressure.

Prognosis of Conjunctivital Injection

The treatment and recovery patients previously diagnosed with CI relies on a structured and methodical intervention therapy requiring a high level of client participation. 

CI has often been used as an important clue indicative of internal inflammation or bacterial infection among patients presenting to primary healthcare providers for routine medical assessments. Additionally, the condition may also manifest in either a passive or active form which is why physicians recommend regular patient monitoring to track disease progression and the assessment of response to prescribed treatment (Bernstein, 2019). While active CI is common and rarely causes major medical concern, passive CI portends requires immediate medical attention as it is more serious and often caused by infectious diseases. This process may also involve elements of patient education given that it would be important for the patient to gain a clear overview of the condition and risk factors likely to have predisposed them to developing it in the first place. Major risk factors associated with CI include living a sedentary lifestyle with limited movement, frequent smoking, a high sodium diet, and the misuse of alcohol.

Life-Long Consequences Linked to Conjunctivital Injection

Cases of Conjunctivital injection are treatable but are likely to result in severe life-long consequences when patients fail to consult a healthcare provider for a detailed medical review. Nevertheless, it is important to note that the life-consequences suffered as a result of CI affliction are directly proportional to the level of blood pressure imbalance experienced over time. The most common life-long challenge associated with this build-up of blood pressure is the risk of developing chronic heart failure (Jones, 2014). However, patients diagnosed with CI can avert this eventuality through the proper management of initial symptoms while also making drastic lifestyle changes. Conjunctivital injection may also cause severe heart valve problems, kidney failure, liver damage, and heart rhythm problems if left untreated for an extended period hence the need for regular health checks.

Injected Conjunctiva Diagnosis – V.S, age 12 Hispanic Scenario

The Scenario of V.S a 12 year old Hispanic Male with Injected Conjunctiva

V.S., age 12 Hispanic male, presents with a feeling that there is sand in his eye. He had a cold a week ago and woke up this morning with his left eye crusted with yellowish drainage. On physical examination, he has injected conjunctiva on the left side, no adenopathy, and no vision changes. His vision is 20/20. Fluorescein staining reveals no abrasion. He is allergic to sulfa.

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Conjunctivitis Diagnosis

  1. List specific goals of treatment for V.S. who is diagnosed with injected conjunctiva
  2. What drug therapy would you prescribe? Why?
  3. What are the parameters for monitoring the success of the therapy?
  4. Discuss the education you would give to the parents regarding drug therapy.
  5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
  6. What would be the choice for second-line therapy?
  7. What over-the-counter or alternative medications would be appropriate for V.S.?
  8. What dietary and lifestyle changes should be recommended for V.S.?
  9. Describe one or two drug–drug or drug–food interactions for the selected agent.

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Goals of Treatment for Patient Diagnosed with Injected Conjunctiva

The acute bout of conjunctivitis evident from the presenting patient was likely the direct result of either a bacterial or viral conjunctivitis infection. It, therefore, becomes fundamental to set clear and elaborate treatment goals to ensure the patient recovers fully from the disease within no time

 The main initial goal of treatment for the patient is to relieve the presenting symptoms in order to alleviate irritation and to eventually enable him to lead a normal high-quality life. Moreover, another critical objective in treating V. S’s conjunctivitis is to reduce the course of viral or bacterial infection known to induce inflammation among patients. Achieving each of the above-mentioned treatment goals would eventually prove noble and critical to community and public health since treatment essentially prevents further spread this contagious disease among the general population.

First-Line Drug Therapy Prescribed to Treat Conjunctivitis

Broad spectrum antibiotics have long been recommended as an ideal treatment option for patients diagnosed with conjunctivitis. Personally, I would prescribe Levofloxacin as the most appropriate broad-spectrum antibiotic to treat the patient’s microbial infection. Levofloxacin is a first-line antibiotic drug therapy option commonly prescribed to treat bacterial and viral infections such as conjunctivitis and with a low microbial resistance profile (Sheikh & Hurwitz, 2006). Timely intervention is necessary to ensure the disease duration is shortened significantly given that one of its main goals is to prevent further infection. Levofloxacin will also be beneficial in managing and eliminating the copious purulent discharge due to its efficacy in eliminating inflammation. However, regular follow-up sessions remain crucial during recovery and as a measure of the overall efficiency of the prescribed medication.

Parameters for Monitoring Success of Levofloxacin Antibiotic Therapy for Conjunctivitis

Several wide-ranging parameters can be applied in determining the overall success or failure of Levofloxacin therapy in treating conjunctivitis. Successful treatment with the drug would typically result in a drastic reduction in patient’s irritation and reddening of what is commonly referred to as the white of the eye (Jones, 2014). Another important parameter to consider is a substantial and noteworthy reduction in swelling within the conjunctiva or eyelids in response to a broad-spectrum antibiotic therapy with Levofloxacin. Moreover, the success of Levofloxacin therapy can also be gauged based exclusively on the complete elimination of the copious purulent discharge, crusting eyelids returning to normal and an end to the burning sensation.

Patient Education Regimen Regarding Levofloxacin Antibiotic Therapy for Injected Conjunctiva

Today, patient education remains one of the most fundamental activities during treatment.

J et al., (2020) argue that the idea behind patient education is the literal arming of patients with a myriad of relevant medical data directly related to their recent diagnosis and accompanying steps to be followed in order to improve patient outcomes. In this particular case, I would begin my patient education regimen on Levofloxacin Antibiotic Therapy by reminding the patient of the importance of adherence to the treatment plan based on the recommended medication dosage. V.S. will be expected to apply the ophthalmic solution every two hours during the day. However, it will also be important to remind the patient not to apply the drops more than 8 times in a day. The patient should also keep the medicine in a germ-free secure location away from children. In case of a missed dose, the patient should proceed to take the medicine as soon as possible to prevent bacterial colonies from recovering and thriving.

Possible Adverse Reactions to Levofloxacin Antibiotic Therapy in the Treatment of Conjunctivitis

Typically, patients newly diagnosed with conjunctivitis have a duty to tell the prescribing clinical staff whether they are allergic to broad spectrum antibiotics such as Levofloxacin, Ofloxacin, Gemifloxacin, or Quinolone. This is a precautionary measure taken to prevent scenarios where patients suffer severe allergic reactions once exposed to Levofloxacin or ingredients used in its preparation. However, adverse reactions to pharmacological agents is a common fixture during therapy with broad spectrum antibiotics. For instance, an adverse reaction to Levofloxacin antibiotic therapy in the treatment of conjunctivitis may manifest as nausea, diarrhea, heartburn or vomiting (Baum & Barza, 2021). Nevertheless, patients should always remember to consult their primary healthcare provider for professional guidance if the adverse reactions persist.

Avelox as an ideal Second-Line Antibiotic Therapy Option in Treating Injected Conjunctiva

Avelox is a suitable second-line antibiotic therapy option approved by the U.S Food and Drugs Administration (FDA) and is appropriate for treating patients suffering from conjunctivitis. It is of the fluoroquinolones class of broad-spectrum antibiotics and is mainly administered as an injection or in the form of Maxifloxacin Hydro-chloride tablets. However, it is important to point out that the Levofloxacin must first be proved to be ineffective in treating conjunctivitis before resorting to prescribing a second-line antibiotic therapy option. Avelox is a strong broad-spectrum antibiotic with a potential to cause serious side effects which may very well result in death. However, if prescribed, the patient should take the film coated Avelox 400 mg tablets, orally daily, until the final clearing of the bacterial infection.

Over-the-Counter Medications and Alternative Medicine Appropriate for Treating Conjunctivitis

It is fundamental to begin by pointing out that that OTC medications and alternative medicines are largely incapable of treating any common case of viral or bacterial conjunctivitis. Nevertheless, they play an outstanding role in helping patients to cope by helping to alleviate the symptoms. Artificial tears are an example of OTC medication which can play an important role in preventing ocular dryness and inflammation (Nwaele & Satre, 2013). Antihistamines are also a dependable OTC capable of preventing irritation by blocking allergy-causing histamines. A similar effect is also observed with decongestants and vasoconstrictors since they prevent the widening of blood vessels during a histamine-triggered allergic reaction.

Dietary and Lifestyle Changes Recommended for VS

The journey to recovery after suffering from conjunctivitis not only requires pharmacological intervention but also relies on a complete overhaul of diet and lifestyle patterns. A diet consisting of leafy vegetables, fruits, Vitamin A (eggs and dairy products), Vitamin B2 and Zinc are critical in preventing conjuctvitis and in promoting optimal eye health (Sheikh & Hurwitz, 2017). However, VS must remember to avoid the excessive intake of starch and sugary foods known to cause a condition known as catarrhal which is known to signal the possible development of conjunctivitis. VS must also make major lifestyle changes such as avoiding a sedentary lifestyle and trading it for physical activities such as regular exercise and wellness routines such as Yoga.

Drug-Drug and Drug-Food Interactions when taking Levofloxacin

Drug-Drug Interactions

  • Chelation Agents: Levofloxacin interacts with chelation agents, such as antacids and multivitamins, and may hinder gastrointestinal movement.
  • Warfarin: Levofloxacin is also known to interact with Warfin; causing a post-marketing effect characterized by the enhancing of its effects and elevations in prothrombin time.

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Drug-Food Interactions

  • Dairy Products: Patients taking Levofloxacin should avoid dairy products such as cheese, yogurt, and milk 2 hours before and after taking the medication to minimize the chances of an adverse reaction or possible side effects (Iacobucci, 2016).
  • Multi-Vitamins Containing Mineral Supplements: Multi-Vitamins with active components consisting of a mineral supplement base should be avoided when a patient is on Levofloxacin since it may hinder the process involved in its absorption to the blood thus reducing its general efficacy.
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