APA format in a SOAP Note format.  1 page long with questions as to which diagnosis would be accurate and why.  I have included the references I need 3 peer review articles to be included

Patient Information:

Initials: JS  Age: 11   Sex: M  Race: Caucasian

SJ

CC: Patient complaining of a mild right earache for the last two days and trouble hearing from that ear.

HPI: James Jones is an 11 year old Caucasian male who presents to the clinic with complaints of a right earache for the last two days. The patient reports worsening pain at night when trying to fall asleep and difficulty hearing out of that ear.  The patient rates is earache pain 5/10 and describes it as sharp and constant. The patient has taken 600mg ibuprofen with minimal relief of pain. The patient reports that he has been spending a lot of time swimming in the pool this summer.

Current Medications:

1.  Ibuprofen 600mg PRN for earache pain

Allergies: NKA

PMHx: Up to date on all immunizations. No significant PMH.

Soc Hx: Patient lives with two siblings and supportive parents in a safe neighborhood in Boston. The patient is currently in middle school and enjoys playing soccer, fishing with his dad and swimming in his pool during the summer. 

Fam Hx: Maternal grandmother died of a stroke at the age of 70. No other significant family history.

ROS: 

GENERAL: No fever, fatigue or chills. No weight loss. 

HEENT: Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears: Patient reporting pain in right ear and hearing loss. Nose, Throat:  No sneezing, congestion, runny nose or sore throat. 

SKIN: No rashes or itching.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

GENERAL: Patient comes to the clinic with his grandmother, patient appears uncomfortable, is rubbing his right ear and having difficulty hearing. 

HEENT: PEERLA. Ears: Right ear canal is erythematous and edematous with pus present, tympanic membrane is difficult to visualize. Hearing difficulty with right ear. Left ear canal is intact without erythema or edema, tympanic membrane is clear and intact. Nose: Nose is patent without any rhinorrhea. Throat: Oropharynx is clear, without erythema or exudates, mucous membranes are moist, pink and intact. (Sullivan, 2012).

SKIN: Skin color is normal for patient, intact, without rashes or lesions. Skin turgor is good. 

RESPIRATORY: LS CTA bilaterally, no sternal retractions noted.

GASTROINTESTINAL: Abdomen is soft, nontender, nondistended. + BS in all quadrants. No bruits noted. No splenomegaly or masses present. 

NEUROLOGICAL: Cranial nerves II to XII are grossly intact w/out focal neurological defecits (Sullivan, 2012).

LYMPHATICS: No enlarged nodes. 

ALLERGIES: No known allergies. No history of asthma, hives, eczema or rhinitis.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

Otoscopy: Otoscopy of the ear canal demonstrated erythema, swelling and there was difficulty visualizing the tympanic membrane as there was watery discharge present. According to Lieberthal (2013), otoscopy is usually sufficient enough to reach the diagnosis of  otitis externa in children, however, certain cases require additional diagnostics, especially when occurring in infants presenting with fever. 

Labs: N/A

A.

Differential Diagnoses:

1.  Otitis externa – I chose this as the primary diagnosis because of the patient’s presenting symptoms and the context in which the patient experienced the symptoms. The patient complained of worsening ear pain and hearing loss in the right ear. The patient also reported that he had been swimming in the pool a lot recently. According to Wald (2018), otitis externa often occurs in children after swimming, causes pain and conductive hearing loss if pus or discharge is present and clinical findings include an erythematous, edematous ear canal and difficulty visualizing the tympanic membrane.

1. Acute otitis media- Acute otitis media is another possible diagnosis for this patient because of his presenting symptoms. According to Thomas (2014), acute otitis media generally occurs in patients after a respiratory tract infection and symptoms can include fever, fatigue or malaise. Additionally, Thomas (2014) discusses how purulent discharge is usually present with a bulging tympanic membrane. However, the patient did not report respiratory tract infection related symptoms and was not febrile.   
2. Otitis media with effusion- Otitis media with effusion cannot be ruled out because there is often discomfort in the affected ear with conductive hearing loss, however, there is not usually any purulent fluid in the canal, nor is it associated with swimming (Thomas, 2014).
3. Upper respiratory infection- upper respiratory infection is another possible diagnosis for this patient as it can cause blocking or painfulness in the ear as well as an erythematous tympanic membrane (Pettigrew, 2011). Additionally, upper respiratory infections often times precede otitis externa or other ear infections.
4. Furunculosis- Furunculosis is another possible diagnosis for this patient. Furunculosis is

usually an infected hair follicle in the ear canal that leads to otalgia and tenderness of the

ear which this patient presented with. However it is not too likely as it usually affects the

cartilage of the year and does not lead to conductive hearing loss (Ibler, 2014).

                                                            References

Ibler, K., & Kromann, C. (2014). Recurrent furunculosis – challenges and management:

a review. Clinical, Cosmetic and Investigational Dermatology, 7, 59-64.

            doi:10.2147/ccid.s35302

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson,

M. A.,  . . Tunkel, D. E. (2013). The diagnosis and management of acute otitis      

            media. Pediatrics, 131(3), 964-999. Retrieved September 25, 2018, from 

            http://pediatrics.aappublications.org/content/pediatrics/131/3/e964.full.pdf

Pettigrew, M. M., Gent, J. F., Pyles, R. B., Miller, A. L., Nokso-Koivisto, J., &     

            Chonmaitree, T. (2011). Viral-bacterial interactions and risk of acute otitis

            media complicating upper respiratory tract infection. Journal of Clinical     

            Microbiology, 49(11), 3750-3755. doi:10.1128/jcm.01186-11

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.

            A. Davis.

Thomas, J. P., Berner, R., Zahnert, T., & Dazert, S. (2014). Acute Otitis Media—a

            Structured Approach. Deutsches Ärzteblatt International, 111(9), 151-160.

            Retrieved September 25, 2018, from

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965963/pdf/Dtsch_Arztebl_Int-                           

            111-0151.pdf.

Wald, E. R. (2018). Acute otitis media in children: diagnosis. UpToDate. Retrieved         

            September 25, 2018, from https://www.uptodate.com/contents/acute-otitis-media-

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APA format 1 1/2 pages long 3 references 1 from the discussions reference list

due 10/24/19 at 7pm

 Incorporating Technology in Community-Based Learning

            Unique learning needs exist in all patient populations.  However, identifying the need and then designing a technology-based intervention requires a careful analysis of both the population and the planned action.  The purpose of this discussion is to describe a community-based population, describe a selected learning need for this population, and explain how I would design a PowerPoint presentation that would address that need. 

Community-Based Population

            I work in a Federally Qualified Health Center (FQHC) that provides primary care to patients across the lifespan.  FQHCs receive funding from the Health Resources and Services Administration Health Center Program to provide care in medically underserved communities (Health Resources & Services Administration [HRSA], 2018).  Over 28 million people receive care at FQHCs in the United States (HRSA, n.d.).  FQHCs use a sliding scale fee, ensuring patients have access to affordable medical care (HRSA, 2018).  While FQHCs are intended to serve the medically uninsured, over 77% of the patients receiving care at FQHCs have private insurance, Medicare, Medicaid, or another governmentally funded health insurance (HRSA, 2019).  Females represent 57.65% of the patient population, with patients between the ages of 25 and 69 years old presenting most frequently (HRSA, 2019).  However, the FQHC patient population possesses unique barriers to care.  A significant hurdle for FQHCs to overcome is language, as 23.63% speak a language other than English (HRSA, 2019).  Additionally, 68.23% of the patient population is at or below the poverty level (HRSA, 2019).  Complicating continuity of care with this patient population is the high number of migratory and seasonal workers and homeless individuals receiving care (HRSA, 2019).  All combined, these factors create a patient population with sub-par health literacy.

Learning Need

            Indigent patient populations are more likely to have decreased health literacy levels (Whitley, Jones, Hansen, & Vora, 2019).  Additionally, patients with diminished health literacy are less likely to return for follow-up care as scheduled (Thompson et al., 2015).  Patients who are chronically under- or uninsured do not return for follow-up appointments as medical is not always viewed as a necessity.  Failure to follow-up for appointments as scheduled has been shown to increase emergency department visits and worsen patient outcomes (Arora et al., 2015).  Therefore, a means to address the FQHC patients’ knowledge deficit of the need to return for follow-up appointments should be identified and implemented. 

Addressing the Learning Need

            As previously identified, members of FQHC patient populations have decreased health literacy resulting in noncompliance with follow-up appointments and poorer patient outcomes.  However, a systematic review of 60 studies identified text messages as an effective intervention to improve patient compliance, thereby increasing patient outcomes (Hirshberg, Downes, & Srinivas, 2018).  Text messages provide a low-cost, highly scalable intervention to improve patient follow-up (Arora et al., 2015).  Additionally, few members of society do not have access to a mobile phone.  Text messages sent seven days, and one day before scheduled appointments are effective intervals for improving patient follow-up (Arora et al., 2015).  Potential obstacles for this intervention include patients changing their mobile numbers, having limited data usage, and the inability to know whether the message was received.  However, using text messages to reinforce the need for compliance with follow-up care will address the learning deficit for this patient population.  Additionally, orientating the office staff and then including them in the implementation of this intervention will address the staff’s learning need.  Therefore, a PowerPoint presentation should be designed to orient the staff to this technology-based, evidence-based intervention.

Summary

            Learning needs exist in all patient populations.  Ongoing advances in technology are providing new methods for addressing these needs.  By taking advantage of these technologies, evidence-based interventions can successfully be implemented in the practice setting.     

Reference

Arora, S., Burner, E., Terp, S., Nok Lam, C., Nercisian, A., Bhatt, V., & Menchine, M. (2015). Improving attendance at post–emergency department follow‐up via automated text message appointment reminders: A randomized controlled trial. Academic Emergency Medicine, 22(1), 31-37.

Health Resources & Services Administration. (2018, May 8). Federally Qualified Health Centers. Retrieved from https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html

Health Resources & Services Administration. (2019). 2018 Health Center Data. Retrieved from https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2018&state=

Health Resources & Services Administration. (n.d.). HRSA Health Center Program. Retrieved October 1, 2019, from https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenter factsheet.pdf

Hirshberg, A., Downes, K., & Srinivas, S. (2018). Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: A randomised clinical trial. BMJ Quality & Safety, 27(11), 871-877. doi:10.1136/bmjqs-2018-007837

Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., & Singh, K. (2015). Barriers to follow-up and strategies to improve adherence to appointments for care of chronic eye diseases. Investigative Ophthalmology & Visual Science, 56(8), 4324-4331. doi:10.1167/iovs.15-16444

Whitley, M. Y., Jones, E. M. V. W., Hansen, B. K., & Vora, J. (2019). The impact of self-monitoring blood glucose adherence on glycemic goal attainment in an indigent population, with pharmacy assistance. Pharmacy and Therapeutics, 44(9), 554. doi:10.43 21/s1885-642×2006000400006

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Select an ethnic minority group that is represented in the United States (American Indian/Alaskan Native, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, or Pacific Islander). Using health information available from Healthy People, the CDC, and other relevant government websites, analyze the health status for this group.

In a paper of 1,000-1,250 words, compare and contrast the health status of your selected minority group to the national average. Include the following:

1. Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group?
2. What are the health disparities that exist for this group? What are the nutritional challenges for this group?
3. Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors.
4. What health promotion activities are often practiced by this group?  
5. Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.
6. What cultural beliefs or practices must be considered when creating a care plan? What cultural theory or model would be best to support culturally competent health promotion for this population? Why?

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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NO PLAGIARISM

A PESTLE Analysis identifies political, economic, social, technological, legal, and environmental factors. Review PESTLE Analysis at the following https://www.groupmap.com/map-templates/pestle-analysis

The U.S. health care system costs $3.3 trillion last year and delivered too little value (Blumenthal, 2017). For most Americans, health care is not only expensive but also fragmented, inconvenient, and physically inaccessible.  Aetna, CVS, UnitedHealth Group and DaVita are health care stakeholders who are engaging in mergers and acquisitions to produce a higher quality product.  Review the article “Is M&A the Cure for a Failing Health Care System?” at https://hbr.org/2017/12/is-ma-the-cure-for-a-failing-health-care-system in Harvard Business Review.

Congratulations; you have been selected as the new Chief Executive Officer (CEO) of a local hospital.  Within six months of taking the job, you learn your health care organization is considering a merger.  Your first task is to conduct a PESTLE Analysis.  Use critical thinking skills and metacognition to research current events in the macro environment of the local hospital in your area.  Your hospital selection will be the same hospital used throughout this course. MY HOSPITAL IS ( UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCE ).  Review the website information on your hospital selection and prepare a 10-slide Microsoft PowerPoint narrative using a PESTLE Analysis 

Your 10-slide PESTLE PowerPoint should follow this format:

1. Slide 1: Cover Page a. Include the title of your paper, your name, the course number and course title, your professor’s name, the university’s name, and the date.
2. Slide 2: Background / Executive Summary a. Describe the details of the situation. Use bullets with short sentences. The title of these slides should be Executive Summary.
3. Slide 3: Thesis Statement a. Identify the focus of your research. The title of this slide should be Thesis Statement.
4. Slides 4-9: Supporta. Support your Thesis Statement following the SESC formula: State, Explain, Support, and Conclude.  (Use Sublevel 1 and 2 Headings to provide coherence and organization. An overview of using the Sublevel 1 and Sublevel 2 headings is provided in the following video https://www.youtube.com/watch?v=yr185y-fAks. Provide in-text citations using the format in the American Psychological Association (APA) Manual 2010, 6th Edition.)
5. Slide 10: References 
   1. Locate peer reviewed journal articles to support your responses.  For example, identify clinical quality that does not compare to other hospitals, see https://www.medicare.gov/hospitalcompare/search.html. Use APA format for your references. (To help you with APA in-text citations and your Reference list, some students use Citation Machine at http://www.citationmachine.net.) 

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