Category Archives: Medicine and Health

Diverse Workforce

Traits associated with the Baby Boomers

Baby boomers represents the fraction of the population born between 1946 and 1964. They hold unique beliefs and values that sets them apart from other generational groups. One of their key characteristics is a strong work ethic. Baby boomers acknowledge the fact that success comes through hard work. They are optimistic in that they set goals and work hard at achieving the set goals. Baby boomers know how to stay focused on accomplishing their dreams. A large segment of baby boomers has experienced self-actualization since they were raised in a period of mass middle class affluence. For the baby boomers, work helps them achieve self-actualization. Baby boomers are team oriented, in that they have a strong sense of community (Tolbize, 2008).

Traits associated with the Millennials

Millennials are much concerned with global affairs. They are concerned about what is happening in other countries, in terms of business and politics. Another key characteristic of the millennials is that they are tech savvy. The millennials were born in the era of great technological advancement and discovery. As such, they are more likely to use social media and other digital tools such as crowdsourcing and teleconferencing. The millennials are more tolerant of other cultures or beliefs. They were born in an era of diversity; interacting with people from different social backgrounds (Tolbize, 2008). Millennials are realistic in that they like to voice their opinion regardless of the situation. For instance, they can even challenge the status quo. Millennials have a zeal for learning and are the most educated. They are eager to expand their knowledge and amass diverse skills sets in different lines of work.

Major differences

Millennials were brought up in a technologically charged environment. They are more likely to embrace the use of modern technological gadgets in work. On the other hand, baby boomers have little exposure to technology. As such, they prefer using modern technological gadgets only when it is necessary. With regard to attitude, baby boomers are likely to be loyal to a single employer. On the other hand, millennials value changing employers since to them, this is an opportunity to advance their careers or improve their earnings. Baby boomers revere their employers while the millennials are likely to challenge their leaders or employers. With regard to working style, millennials value flexibility. For instance, they prefer flexible arrangements between them and employers that allows them to spend time with family or even attend social events. On the other hand, the baby boomers tend to be static. Both of these generations have gone through different experiences in life such as in areas of technology and media (Gursoy, Maier, & Chi, 2008).

Solution 1: Accommodate personal employee needs

It is important for the organization to accommodate the employees’ personal needs. Since the employees are at different stages of their lives, they may have different challenges that the organization needs to address. For instance, the millennials mar require a flexible schedule to attend to their children’s social events such as parent/teacher functions. They can be allowed to attend such functions and make up for the lost time later. The baby boomers may prefer to work less hours or during specific shifts. The organization should ensure there is parity so as not to make one faction of employees feel secluded (Gursoy, Maier, & Chi, 2008).

Solution 2: Increase flexibility in the work place

Improving flexibility in terms working styles and communication styles can help relieve tension in the organization. These two generations have different working styles, with baby boomers being more of team players while millennials respond well to a structured approach and a challenging environment. In terms of communication styles, baby boomers are more appreciative of meetings, notices, letters, and to an extent emails. On the other hand, the millennials prefer a diverse mix of communication styles including the use of social media (Gursoy, Maier, & Chi, 2008).

Solution 4: Recognition programs

Baby boomers may want to feel encouraged through a higher status. In such a case, they may appreciate recognition when they meet expectations, for instance, recognition during meetings of their exemplary performance. Millennials may appreciate validation and the chance to have additional training opportunities as a way of recognizing their good performance.


  • Gursoy, D, Maier, T. A, & Chi, C. G. (2008). Generational differences: An examination of work values and generational gaps in the hospitality workforce. International Journal of Hospitality Management, 27: 448–458.
  • Tolbize, A. (2008). Generational differences in the workplace. Journal of workplace Learning, 13: 57-65. Retrieved from


A Case Study on Bone Tissue, Structure and Repair

A Case Study on Bone Tissue, Structure and Repair

A Case Study on Bone Tissue, Structure and Repair

  1. One way bones are classified is by their shape. How would you classify the bones fractured by Mrs. Morgan?

The bones fractured by Mrs. Morgan can be classified in two ways: soft-tissue involvement and by mechanism. In soft-tissue involvement, a number of factors are considered. First, it is important to consider whether it is a closed or open fracture. An open fracture is one that has open or visible wounds similar to Mrs. Morgan’s case. In other words, the fracture hematoma can be seen. Such fractures may be susceptible to infections. A closed fracture is one where overlying skin is left intact after an injury.

Mrs. Morgan’s bones can also be classified depending on the mechanism in which the fracture occurred. This classification has three categories namely: traumatic fractures, periprosthetic fracture, and pathologic fracture. A traumatic fracture is one that results from a sustained trauma such as a fall, as is the case with the patient. A pathologic fracture is related to one or more of the underlying health issues in a patient. For instance, a disease that weakens the bones and hence increasing their susceptibility to fractures. A periprosthetic fracture is caused by a mechanical weakness associated with body implants.

  1. The body of Mrs. Morgan’s vertebra is fractured. What type of bone tissue makes up the majority of the vertebral body? Describe the structure and function of this type of bone.

The vertebral bone is made up of five sections namely; cervical spine, thoracic spine and lumbar spine, sacrum and coccyx. The Seven vertebrae which is curved and concave towards the front while starting at the axis and ending at the center of the second thoracic vertebrae makes up the structure of the cervical spine. The thoracic spine has five vertebrae, it is curved, concave towards the front and starts at the second vertebra and ends at the center of the last thoracic vertebrae.  The Lumbar spine has five vertebras and is more curved in women than in men. It starts at the center of the last thoracic vertebra and ends at sacrovertebral angle. The sacrum has five joined vertebra which starts at the sacrovertebral articulation. Lastly the coccyx has four (three- five) fused vertebrae.

The main function of vertebral bone is to cover the spinal code, the central nervous system which is responsible for transmission of nerves into the body and receive information from peripheral nervous system. Injury to the spinal code is fatal and would thus require tough protection which is provided by the system of vertebrae bones from the base of the neck to the hip bone.

Related: Effect of Weight Lifting

  1. The diaphysis of Mrs. Morgan’s humerus is fractured. What type of bone makes up the majority of the diaphysis of long bones like the humerus? Describe the layers of bone tissue found here.

The type of bone that makes up the majority of the diaphysis of long bones like the humerus are the cortial bone and contains tissues such as bone marrow and adipose.  The Fibroblast, vascular endothelial cells are some of the cells contained in the adipose tissue. The blood vessels which is always accumulated in the subcutaneous layer acts as a shield from heat and cold.

  1. Most connective tissue, including bone, is highly vascular. Which anatomical structures in Mrs. Morgan’s compact bone house blood vessels? What sign or symptom in Mrs. Morgan’s case is directly related to disruption of these structures by her bone fractures? How is the sign or symptom related to these anatomical structures?

The anatomical structure in Mrs Morgans compact bone that house blood vessels is osteon, also known as the haversian system. It is cylindrical in shape and it also has lamellae of compact bone tissue covering the central canal. Disruption of the osteon systems has effects such as the ones experienced by Mrs. Debbie Morgan. She experienced severe back pain, a large open wound on her arm and what appears to be bone tissue sticking out of the skin. She also has bruises covering her left shoulder and killer headaches. These symptoms could be as a result of the haversian system.

  1. As a fracture is repaired, new bone is added to the injury site. What term is used to describe the addition of new bone tissue? Identify which bone cell is responsible for this process and explain how it occurs.

The process in which addition of new bone tissues is added to an area where injury has taken place is known as ossification or it can also be referred to new bone formation. Osteoblasts is a cell responsible for secreting new bone, with the help of other hormones such as vitamin D, growth steroids, parathyroids and calcitocin.  The Osteoblast cells are produced by osteoprogenitor cells and are found on the surface of osteoid seams. A protein mixture known as osteoid is formed during these process and in which it later mineralizes to become bone to complete the process of bone formation.

  1. In the final stage of bone repair, some of the osseous tissue must be broken down and removed. What term is used to define the breaking down of osseous tissue? Which bone cell would be best suited for this task?

Bone metabolism also referred to as modeling is a term used to describe breaking down of old bone tissues to pave way for formation of new ones. Osteoclast is the cell responsible for the breaking down of osseous tissues; they are large and multinucleated cells that are found on the bone surface.


Benefits of Weightlifting

Prostate Cancer-Strategies to promote healthy lifestyles


 Discuss the causes of and risk factors for the problem.

 Provides data to support the magnitude of the problem. How many people die or get sick each year from this health problem? Is this a problem that affects women? If so are there any differences in its impact on men vs. women? Are there ethnic, racial, or economic class variations?  What is the yearly cost of this problem?

Identifies strategies to promote healthy lifestyles:

 Identifies wellness behaviors to promote a healthy lifestyle.

  Provides at least 2 web resources for information on the health problem.

Identifies current treatment measures:

 Discusses the current treatments for the problem?

How effective is the treatment?  Discuss any barriers to treatment such as side effects or high cost.

Sample paper

Prostate Cancer

Prostate cancer is one of the most common cancers affecting men worldwide. In the United States, prostate cancer is the second leading cause of cancer deaths after lung cancer. Prostate cancer, like all other types of cancers, begins with unregulated cell division or growth. The unregulated cell growth has the potential to spread and invade other tissues of the body (Simon, 2004). Cancer begins when a single cell, also known as the malignant cell, undergoes abnormal cell division. Through continuous cell division, the malignant cell divides to form about 1 billion new malignant cells in not less than 30 generations (Simon, 2004). The 1 billion malignant cells form the smallest tumor that can be medically detected. The unregulated cell division continues, and the tumor increases in mass and area. With time, the tumor invades adjacent tissues, lymph channels, and blood vessels. Cancer cells may be carried to the healthy tissue through lymph channels and blood vessels, where they cause spread of cancer to the new tissues or organs.

There are certain risk factors associated with prostate cancer. Age is one of the risk factors that lead to prostate cancer. Prostate cancer is rare in men below the age of 40. Between 40 to 50 years, the disease is also uncommon. From 50 years, the risk of developing prostate cancer among men begins to rise. This risk continues to increase as an individual progress in age. For instance, men between age 50 and 59 have a 10% to 42% risk of developing prostate cancer, while those between 70 to 79 have a 25% to 66% risk of developing prostate cancer (Simon, 2004). Another risk factor for prostate cancer is a family history of cancer. There is a high risk of developing prostate cancer if there is a history of the disease in one’s family. For instance, men with a close relative (brother or father) diagnosed with prostate cancer are two times likely to develop the disease comparing to men whose families have no history of cancer.

Another risk factor is the nationality. According to Simon (2004), prostate cancer is more prevalent in the United States comparing to rural China and Japan. However, scientists argue that the reasons behind the different prevalence rates are due to genetic factors, environmental factors, and the lifestyle of individuals. This leads to the next risk factor, diet. Research indicates that poor diet (for instance eating too much red meat) increases the risk of developing prostate cancer and other types of malignancies. Race is another risk factor for prostate cancer. Various studies indicate that African-Americans are at a higher risk of developing prostate cancer than whites, even while taking into consideration age and poverty levels. Smoking also increases the risk of developing prostate cancer among men. Lastly, hormones may play a part in increasing the risk of prostate cancer. Men with higher levels of testosterone hormone are at an increased risk of prostate cancer.

Prostate cancer is prevalent among men above the age of 50. According to the American Cancer Society (ACS) (2016), one in seven men will be diagnosed with the disease during his lifetime. The risks are higher among men who are 65 years and older; about 6 in 10 men will be diagnosed with prostate cancer. Estimates indicate that in the current year, about 161,360 men will be diagnosed with prostate cancer in the United States. Further, about 26,730 deaths will occur from prostate cancer. Prostate cancer does not affect women. Racial, ethnic, and economic class variations do exist. Regarding race, prostate cancer is more common among African Americans than Whites (Simon, 2004). This could be due to genetic factors. Prostate cancer is also more common in the United States, particularly San Francisco than in rural China where it is 120 times less frequent. In terms of social class, those in the lower class are at higher chance of dying from prostate cancer due to late diagnosis and treatment.

There are several treatment options available to men suffering from prostate cancer. Treatment options are specific for each case, and may involve a combination of two or more options. The first option is surgery. This approach entails the surgical removal of the prostate gland and the surrounding tissues (“ACS,” 2016). Seminal vesicles are also removed. The medical term for this procedure is radical prostatectomy. Surgery is effective only when cancer has not spread to the nearby tissues or other parts of the body. Possible side effects include erectile dysfunction, urinary incontinence, and problems that may arise during surgery such as infections at the surgical site. The second treatment option is radiation therapy, which entails the use of high-energy rays to kill the malignant cells (“ACS,” 2016). Radiation therapy is effective when the prostate cancer is not widespread. On the other hand, radiation therapy can help prevent symptoms from emerging early in a situation when cancer has spread to nearby tissues. Barriers include side effects such as erectile dysfunction, urinary problems, and bowel problems.

Another treatment option is cryotherapy. This refers to the use of cold temperatures to freeze cancerous cells (“ACS,” 2016). This treatment procedure is effective in treating prostate cancer at the early stages. Cryotherapy is often used when cancer comes back following radiation therapy. Barriers to treatment include the risk of erectile dysfunction, urinary incontinence, and problems with rectum and bladder due to damage to nerves. Hormone therapy is another treatment option (“ACS,” 2016). This involves taking measures to lower the levels of androgens or male hormones in the body. Androgens are responsible for the growth of cancer cells. Hormone therapy cannot entirely cure prostate cancer but can help reduce the growth of cancer cells. It is effective if cancer has spread too much or after cancer comes back following surgery or radiation therapy (“ACS,” 2016). This treatment option has many side effects. These include low sexual drive, hot flashes, erectile dysfunction, heart problems, depression, osteoporosis, fatigue, low mental sharpness, breast tenderness, and others.

Chemotherapy is another treatment option for prostate cancer. Chemotherapy refers to the use of chemical drugs to cure cancer (“ACS,” 2016). These drugs are given orally or intravenously. The drugs kill cancer cells throughout the body. Chemotherapy is effective in treating metastasized cancer. However, it is only useful when used in combination with other treatment options such as hormone therapy or surgery. Barriers to treatment include various side effects such as nausea and vomiting, hair loss, loss of appetite, diarrhea, bleeding, and a higher chance of acquiring infections. The last treatment option is the vaccine treatment. This vaccine works by inducing the body’s immune system to kill the cancer cells (“ACS,” 2016). This treatment option is suitable for treating advanced prostate cancer. However, this treatment cannot eliminate cancer and has to be used in combination with other treatment options. The major barrier in using this treatment procedure is high cost.

Certain behaviors may promote healthy lifestyles among men. The first behavior relates to a healthy diet. Maintaining a healthy diet can help in preventing chronic illnesses like heart diseases, diabetes, obesity, cancer, and among others (Booth, Roberts, & Laye, 2012). Consumption of excessive calories from sugar, fat, or starch can increase the risk of developing chronic diseases and including prostate cancer. People should avoid eating too many sugary foods and moderate on salt intake. Another behavior that may promote healthy lifestyles is exercise. Physical activity is crucial in helping people maintain a healthy way of life. Maintaining high levels of physical activity enables one to avoid unhealthy weight gain, which is a major risk factor for chronic diseases (Booth, Roberts, & Laye, 2012). Physical activity such as brisk walking, lifting weights, dancing, and others have a significant positive impact on health.

Another strategy to promote a healthy lifestyle is to ensure that one attends regular medical checkups even without the presence of a disease. Regular checkups can help detect the presence of cancer at an earlier stage when it is possible to treat (Booth, Roberts, & Laye, 2012). For instance, men above the age of 50 should attend medical screening for prostate cancer since they are at increased risk of the disease. Another wellness behavior concerns health literacy. Health literacy is the ability access basic health information as well as services for appropriate decision-making. Health literacy can enable individuals to improve their health since they can be able to access healthcare at the right time. Further, it allows people to learn how to navigate the healthcare system. Such people can easily locate the appropriate health providers depending on their needs.


American Cancer society. (2016). Treating prostate cancer. Retrieved from   

Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic             diseases. Comprehensive Physiology2(2), 1143–1211.

Simon, H. B. (2004). The Harvard Medical School Guide to men’s health: lessons from the          Harvard Men’s Health Studies. New York, NY:  Simon and Schuster.




AMBULATORY SURGERY CENTER CASE STUDY- Reimbursement Issue and Role of U.S. HealthCare Sector

Speaker notes

ØThe significant players in the United States health care platform includes:

üProviders; consist of those groups that provide services like clinics, hospitals, nursing homes etc.

üPurchases; it involves governments, employers and the group of private Purchasers.

üSuppliers; comprises medical, pharmacy, and other related industries.

üInsurers; comprises of agencies that deal with insurance such as Medicare, Medicaid and Medicare.

ØThe governments, employers, and individuals are the group of Purchasers who supply funds to private and public Insurers.

Ø Insurers then play the role of reimbursing providers and suppliers by disbursing a percentage of the funds collected from Purchasers.

ØThis system considers both purchasers and Insurers as the key “payers”, and there is a fundamental conflict existing between them and the Suppliers and providers who get the payments made(Fiscella, 2011).

ØTherefore, Insurers and purchasers usually have a preference of reducing the health care payments, whereas suppliers and providers are keen on maximizing their receipts. So, health care costs “represents an intense battlefield among the competing interests”.

ØThe governments, employers, and individuals are the group of Purchasers who supply funds to private and public Insurers.

Ø Insurers then play the role of reimbursing providers and suppliers by disbursing a percentage of the funds collected from Purchasers.

ØThis system considers both purchasers and Insurers as the key “payers”, and there is a fundamental conflict existing between them and the Suppliers and providers who get the payments they make.

ØTherefore, Insurers and purchasers usually have a preference of reducing the health care payments, whereas suppliers and providers are keen on maximizing their receipts. So, health care costs “represents an intense battlefield among the competing interests”.

ØBefore taking any health insurance cover, millions of Americans expect to see the health cover benefits

ØACA was initiated with a view of overcoming the shortcomings that arise due inadequate supply and implant costs. Salaries, rent, utilities, taxes, and other operating costs are going up and more regulatory requirements are being introduces;

ØCollectively, all these contribute to decreased satisfaction by those seeking health care.

ØIt is then required of ACA to increase their access to deliver adequate healthcare to the citizens

ØHealth care system is still facing serious problems of health professionals on the issue of reimbursement deteriorating system that requires a lot more to meet the current demand that has gone up (Rosenbaum, 2011).

ØThe present system is mainly facing the problem of growing volume, and load of the health care system, escalating costs, increased accreditation standards,and the system of reimbursement as well as well-trained healthcare practitioners.

ØManagers who are regarded as health care leaders and policy makers have made trials of totally modifying healthcare system in order to reduce the present errors and realize better health care outcomes in the country.

ØMajor reforms are therefore expected in the health care system and the ACA. They should focus on key standard strategies for professionals regarding the system of reimbursement that is has been recently on a decline (Rodwin, 2003).

ØManagers however need to realize that ACA and the entire healthcare system require a lot more to address the current demand that has escalated.

ØThe fee-for-service plan requires patients to typically search for a doctor they prefer and want to get the reimbursement for “covered” health expenses from.

ØACA faces a number of key drawbacks on issue of reimbursement, and these challenges involve:

üA stagnant transition to the current updated ASC payment system,

üSeparate remittance for certain devices, drugs, and biologicals,

üThe gap present between ASCs and the remittance to outpatient departments in hospitals and

üSite of service issues.


ØA revised methodology of Payment should be initiated

ØThe Current Payment Methodology should completely replace the traditional ASC Payment System

ØStandard overhead amount for any medical procedure should be derived from an estimation of incurred costs by ASCs in providing the services related with the procedure on condition that the remittance will be significantly less than it would have been if the procedure was performed on the basis of inpatient (Ash, Berg & Coiera, 2004).

ØThis should lead to a single payment system to be launched to address issues that reduce the complex and lower cost group and reduce complexity level.

ØNevertheless the inflation rate along with covered surgical procedures should be adjusted.

ØThe old methodology of payment was covered under the Payment Medicare Physician Fee Schedule (MPFS) to healthcare providers that may as well be billed the CPT codes for the brachytherapy sources application in the ASCs.

ØHowever, a revision of brachytherapy payment system which was not recognized in the old ASC payment system was introduced.  This new system of payment is separately payable.

ØInitially, drugs and biologicals were incorporated into the ASC payment under the old ASC payment system.  But the revised policy demands that the drugs and biologicals should be separately paid for (Watkins et al., 2015)

ØACA will bring about the improvement of the health care reimbursement problem with the aid of Health Information Technology (HIT).


ØIn conclusion, the policymakers must aim at revising the range of the issues associated to healthcare policies to improve several opportunities that can ensure enhancement of patient care services and health care opportunities.

ØIt is evident that reimbursement rates are deteriorating constantly along with the supply and implant costs, salaries, rent, utilities, and salaries.

ØThe healthcare system as it stands today is facing numerous emerging challenges.   Americans taking benefit of health policies are continually rising; however, foreclosure and bankruptcy are presently threatening the stability of health care system in the US with respect to financial system. This must be amended generally to improve the health care in the country.


vAsh, J. S., Berg, M., & Coiera, E. (2004). Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors. Journal of the American Medical Informatics Association : JAMIA11(2), 104–112.

vFiscella, K. (2011). Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions. Annals of Family Medicine9(1), 78–84.

vRosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports,126(1), 130–135.

vWatkins, K. E., Farmer, C. M., Vries, D. D., & Hepner, K. A. (2015). The Affordable Care Act: An Opportunity for Improving Care for Substance Use Disorders? Psychiatric Services (Washington, D.C.)66(3), 310–312.

vRodwin, V. G. (2003). The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. American Journal of Public Health93(1), 31–37. Barlas, S. (2014). Hospitals Struggle With ACA Challenges: More Regulatory Changes Are in the Offing in 2015. Pharmacy and Therapeutics39(9), 627–645.

A Structured Stakeholder Analysis

A Structured Stakeholder Analysis

Stakeholders in the healthcare sector are bodies or individuals that are involved in the healthcare system and are affected by any reforms made to the system. Some of the major stakeholders in the healthcare industry include patients, insurance companies, physicians and pharmaceutical firms. Various stakeholders play different roles depending on their mission. However, they are all aimed at ensuring quality medical care for all. In the healthcare sector, there are various stakeholder organizations that have come up. They are all focused on different issues such as those diseases with no cure or particular groups in society that need assistance with their healthcare. Through this programs, even those who are not well-off financially are able to access healthcare services.

The Stakeholder organization that I chose for this analysis is the Maryland Children’s Health Program (MCHP).This program began in 1998 July with the aim of providing full health benefits to children under 19 years of age. These children are able to receive medical care from various Managed Care Organizations through the MCHP which makes use of state and federal funds to ensure children from low-income families have access to healthcare services. Any children under 19 years who do not qualify for Medicaid, are uninsured and have a modified adjust gross income either at or below 300% of the federal poverty level are eligible for MCHP (Volden, 2006).

            Maryland Children’s Health Program is committed to ensure that all Maryland children have access to quality healthcare regardless of the financial status of their families. Children from low-income families benefit tremendously form this program. Through MCHP, they have access to services such as doctor visits, lab tests, prescription medication and dental and vision care. MCHP desires to enable children to grow up healthy so that they can live to fulfill their dreams and even change their lives and that of their families (Szilagyi, 2004). Through this, they give these children a chance for a brighter future and improve their lives and of the community as a whole.

            There are four major players in the healthcare sector; patients, providers, payers and producers. Patients are individuals with medical needs who go to providers for medical care.  The entire industry exists because of patients who create a demand for healthcare services. Providers are institutions or individuals that provide healthcare services to patients, purchase products from vendors and charge payers for the care given to patients. On the other hand, payers refers to entities that are responsible for paying providers for the healthcare services rendered to patients. These entities include governments, individuals, insurers and private employers. Producers are those responsible for selling pharmaceutical products, medical devices and other related products.

            Maryland Children’s Health Program is among the payers in the health sector. This program pays for healthcare services for children below the age of 19 years who cannot afford quality healthcare. Through the MCHP premium, uninsured children under 19 years of age from families with low income get access to healthcare coverage at an affordable  monthly premium through Maryland Managed Care program; Health Choice. Under this coverage, children are able to access even the otherwise costly services such as mental health services, vision care and dental care.

            There are various Managed Care Organizations one of them being Priority Partners which is owned by Johns Hopkins. This organization works with MCHP to provide healthcare services to its members. Priority Partners prides itself for making it possible for people from all backgrounds to access quality healthcare. It offers no-cost benefits to MCHP members such as immunizations, doctor’s visits, screenings and X-rays just to name a few. This organization believes in helping low-income families stay healthy which in turn improves their living standards (Volden, 2006).

            The Maryland Children’s Health Program is headed by the Maryland government. The government initiated this program to ensure that children as well as pregnant women who cannot afford quality treatment can access it at low-cost healthcare coverage. The Maryland government is critical to the MCHP since it is though it that the program is able to access federal and state funds which are used to pay for healthcare services for their members. However, the Maryland government is generally important because it holds the key to important healthcare reforms and budgetary decisions which can either improve or bring down the healthcare sector. In order to better perform its role in the healthcare industry, the government could work together with the healthcare department as well as private agencies and other NGOs that work towards quality and affordable medical care.

            The future of any society is dependent on its young generation who will grow to lead and open new opportunities for future generations. They are a priceless asset in the community and deserve to get the best even when the families they come from are not fortunate enough to provide all that. The government and other entities have a huge role to play in the healthcare sector to ensure that the fatality rate especially that of children is completely minimized. The MCHP is a beginning for Maryland and a good example for other states all over the world of just how important the lives of the young generation is and what can be done to ensure they are protected.


Szilagyi, P. G. (2004). Improved access and quality of care after enrollment in the New York State Children’s Health Insurance Program (SCHIP). Pediatrics, e395-e404.

Volden, C. (2006). States as policy laboratories: Emulating success in the children’s health insurance program. American Journal of Political Science, 294-312.



Because many aspects of health care operations are changing, health care administrators oversee a wide variety of projects.

Project Management Planning

Because many aspects of health care operations are changing, health care administrators oversee a wide variety of projects. These can include logistical projects such as moving a department to a new facility, technology-related projects such as introducing a new system or piece of equipment, or process-related projects such as initiating new procedures for patient discharge. If the project has any degree of complexity, it will benefit from a project management approach. Administrators and managers in health care need to have a working understanding of project management: why it is important, what it accomplishes, and the repercussions on the organization if its basic tenets are ignored or not followed. Within project management, the project plan is the cornerstone of successful execution of a project. The project plan is designed to guide the process and execution of a project.

For this Assignment, you will develop a project plan, using as your focus a work-related project you are doing now or will be doing in the future.

Managing Recruitment and Selection


Due to the rampant changes in the customer’s demand and technology even in the medical field, there is a need for medical facilities to change their processes and way of doing things to improve their effectiveness and efficiency.  However, to make these changes, the administrators have to implement in phases, and it is usually referred to as a project, and it needs proper manager to ensure all its objectives and goals are achieved at the end. A project is a formal approved document used to guide both project execution and the project control. Since the project execution requires more than one person’s input, proper condition and control are paramount in ensuring that all the policies and guidelines depicted in the project plan are followed to the letter. On the other hand, project planning involves the use of schedules such as Gantt charts to plan and subsequently report the progress within the project environment. This essay will attempt to create a project plan to introduce new equipment in the hospital to aid in increasing the efficiency and effectiveness as well as the quality of the services offered by the facility.

Part 1: Project Description

St. Johns Hospital being one of the best healthcare facilities in the region runs on an outdated dialysis machine which takes the time to serve a single customer. In the worst cases, the machine misbehaves in front of the patients forcing them to be sent to other facilities to get the same service. As a result, the management of the hospital has proposed to buy a new dialysis machine and completely replace the older one. According to the management, replacing the machine is cost effective compared to the regular repairs the machine undergoes and still breaks down after some time. As a result, the proposed project will compose of components such as selection and acquisition, evaluation of equipment for inclusion into the Equipment Management Program, Preventive Maintenance inspection, review of hazards alerts and product recall, incident investigation and orientation and continuing education on how to use and maintain the machine (Kerzner, 2013).


The primary purpose of the project is to replace the old dialysis machine by purchasing the current model in the market.  Moreover, the project will ensure there is a smooth transition from the era of the old machine to a new era with the new machines through training of all workers who will be using the machine in their daily operations on how to operate and maintain to minimize the chances of occurrence of work-related accidents. However, before the implementation of the machine, the management has to conduct a feasibility test to determine the practicality of the new equipment in the hospital before the acquisition.

Project justification

In the recent years, there has been an increase in the number of patients coming to the hospital with kidney failures problems.  Considering that to change a kidney is far much expensive, and an individual will need to have a possible donor, most of the patients opt to take dialysis treatment. Due to the constant failure of our dialysis machine, the hospital is forced to send these patients to other hospitals and the facility fails to maximize the opportunity to attract more customers. As a result, the management of the hospital is certain that a new machine will have positive impacts on the services that are offered in the hospital.


Objectives and goals of the project

  1. After the completion of the project the manager aims to:
  2. Increase the number of customers it serves in a day
  3. Increase the quality of healthcare they offer to their esteemed and target customers.
  4. Increase the efficiency and effectiveness of the workers working in this department.
  5. Cut the maintenance cost that was used to maintain the old machine.
  6. Save on time that is used to serve a single customer as well as increasing the market share by attracting more patients.

Requirements for the project

  1. For the management to successfully complete project it needs:
  2. Enough funds to purchase the new machine
  3. Choose the best alternatives among the available machines.
  4. Train the hospital workers on how to operate and maintain the machine.
  5. The actual purchase and acquisition of the equipment

Tangible measures criteria

  1. To measure the success of the project, the management will need to:
  2. Keep a record of the number of patients treated each and every single day to project the trend and examine if there is an improvement from the old machine(Burke, 2013).
  3. Keep a record of the time that is spent on a single patient to determine if an improvement is noted.
  4. Calculate the cost of maintaining the new machine and compare with the cost incurred to repair and maintain the old machine and examine any notable changes.

Project scope: expected deliverables

After the full implementation of the project the management expects:

  1. To increase the quality of the services offered to kidney failure patients – the hospital is expected to increase its ability to achieve the maximum expectation of their customers by giving them the best care possible in the best comfortable way
  2. To reduce the cost of repair and maintenance of the machine – the hospital was spending large chunk fund to keep the previous machine running, and it is hoping that with the new purchase the funds that were spent in maintenance can be put into other useful projects.
  3. Increase the effectiveness and efficiency of the hospital services – the hospital expects to offer and complete all kidney failure services with a minimum expenditure in terms of effort, money and time while maintaining high-quality service. Moreover, the hospital expected to move closer to perfection by improving the extent to which the target problem is solved.

Acceptance criteria

For the machine to qualify for purchase, it has to meet or surpass acceptance criteria such as:

  1. It has to be assembled in front of the members of the management to test its compatibility with the needs and desires of the hospital.
  2. The spare parts of the machines must be available locally to cut the cost of importing them for repair purposes(Meredith, 2011).
  3. The machine also needs to work on at least ten individuals a single day to meet the demand of clients and decongest the appointment diary.

Project assumptions, risks, and constraints

  1. There is an assumption that the machine will go for not less than three months without breakdown while working on daily basis.
  2. There is an assumption that the machine will serve at least ten patients each day.
  3. The major and primary risk associated with the machine is the machine break down that will halt the operations of the hospital.
  4. The major constraint associated with the new machine is the lack of knowledge among the hospital workers on how to operate it.

Project roles and responsibilities

Project roles and responsibilities

Project name                                       new machine implementation

Project manager                                  Allan G. Smith








selection and acquisition P P      
evaluation of equipment     S P  
preventive maintenance inspection S       P
review of hazards alerts and product recall   S      
orientation and continuing education P   P   S


P= PRIMARY           S = SECONDARY     I = INTERNAL          E = EXTERNAL

Considering the hospital has many departments and stakeholders, each category of the stakeholder has a representative in the senior management that is planning to implement the project. John represents all surgeons, Frank representing all doctors, Leah representing all nurses, Jayne represents the board of governors of the hospital, and Leah represents all medical practitioners dealing with kidney patients.  These members of the stakeholders will be the first lot to undergo training in order to train other members of their teams (Pollack, 2007).  Moreover, to get the full support of the stakeholders, the management will call a meeting with all head of departments to inform them of the impending project who will, in turn, spread the word to all other concerned parties.

Part 2: Grants chart


Task Start Date Duration End Date
selection and acquisition 15/9/2016 2 months 15/11/2016
evaluation of equipment 16/11/2016 1 month 13/12/2016
preventive maintenance inspection 15/12/2016 1 month 13/1/2017
review of hazards alerts and product recall 14/1/2017 1 month 14/2/2017
orientation and continuing education 15/2/2016 3 moths 10/6/2017


For proper and effective implementation of the project the management distributed the intended project time among the tasks in the priority of their significance. The more significant stages were given more time compared to less significant stages.

Selection and acquisition being the first stage were given a period of 2 months which is an ample time to give the team enough time to research on the available and new models of the machine in the market, evaluate all options to make a well-informed decision. Selecting the best alternatives is a complex process that may require the team members to conduct a benchmark or seek an opinion from an expert.

The second, third and fourth stages were given one-month duration each considering that they will be conducted by experts and the suppliers of the machines since they are well conversant with all advantages and disadvantages of the machine as well as all the hazards relating to it (Aloini, 2007). However, these experts must clearly explain to the team each stage to the team so that the team can be aware of what and how to deal with the machine in case of breakdown.

The final stage carries more weight than any other stage and involves training of hospital workers on how to operate the machine. Considering that this is a new model to us, it may take the time to learn, and all the hospital operatives are required give the necessary assistance to see out this exercise because without the knowledge and necessary skills on how to operate the machine it will be useless to the hospital.

The team decided to settle on the top-down and bottom-up estimation method obtaining data from previous projects that have been carried by the hospital as well as getting data from other hospitals which have undertaken a similar project in recent months. Top-down design helps in breaking down structures and data to add estimates for each stage of the project to determine the overall cost in time of efforts and money. Moreover, bottom- up will help in estimating as well as analyzing each stage independently before rolling up estimates from all stages to give a higher value. The selected techniques will succeed because they have succeeded in previous occasions and thus there are minimal chances of failure.

 Part 3 strategies to maintain the project budget

A budget consists of an estimate of income and expenditure for a set period of time and thus, the project team has to ensure the expenditure does not exceed the available funds for the project. The team leader has the obligations to ensure that the team does not extravagantly spend to see the project through. Some of the strategies to maintain a sensible budget include:

  1. Continually forecasting the budget – after the completion of each stage, the project team should review the budget as well as making any necessary changes because the budget needs to be reviewed now and then to prevent failure if a project(Aloini, 2007). Some of the risks associated with this method include lack of enough stress tests and carrying forward of past errors.
  2. Keeping the team informed – since this is not a one man job, all the team members should be well informed of the proceedings and the amount of money at their hands to make the necessary adjustments. By constantly informing his team members of the proceedings, the team leaders is likely to face resistance from some members as well as the spread of biased information.
  • Regularly forecasting resource usage – just like the budget, the team has to keep close tabs on how they use the resources at their exposure or they find themselves short of resources. This strategy is likely to face risks and challenges such as corruption among members where some feels they should have more that they possess, and spendthrift spending as the resources will be reviewed in the near future.

Part 4: risk management, quality management, and sustainability

To effectively and the best way to deal with the risks of this project is to avoid and accept the avoidable risks. Risk avoidance in this project would include avoidance of any action and activity that is likely to result in any kind or loss or misbehave (Meredith, 2011). Moreover avoiding including individuals that are likely to jeopardize the project can help a lot in mitigating the likeliness of failure of the project. However, those risks that cannot be avoided have to be accepted and weathering the impacts and setbacks that they may bring into the project process. However, despite the fact that this strategy is dangerous, the project will deal with the risk in case of occurrence.

To maintain the quality of the project and the machine that is intended to be implemented, the team will have no other option but to constantly fulfill the requirements for quality such as quality inspection and testing. The primary aim of the project is to improve the quality of service it offers to its customers, and thus, it has to regularly test the quality by determining and eliminating causes of unsatisfactory performance and service.

The project needs to make clear choices and effectively and efficiently allocate its resources through a steady accumulation of frameworks promising to unlock the advantages and secrets of competitive advantage and successful completion of the project (Aloini, 2007). To ensure sustainability, there is the need to communicate and create awareness to the team members and all stakeholders of the importance of the project at hand to the hospital and all their customers in general.



Aloini, D. D. (2007). Risk management in ERP project introduction: Review of the                                   literature. Information & Management, 44(6), , 547-567.

Burke, R. (2013). Project management: planning and control techniques. New Jersey, USA.

Kerzner, H. R. (2013). Project management: a systems approach to planning, scheduling,                         and controlling. John Wiley & Sons.

Meredith, J. R. (2011). Project management: a managerial approach. John Wiley & Sons.

Pollack, J. (2007). The changing paradigms of project management. . International journal          of project management, 25(3), , 266-274.

ADHD: Pharmacological vs Non-Pharmacological Treatment

ADHD: Pharmacological vs Non-Pharmacological Treatment

ADHD: Pharmacological vs Non-Pharmacological Treatment

Attention deficit/hyperactivity disorder (ADHD) refers to childhood-onset neurodevelopmental condition typified by developmentally unsuitable levels of impulsivity, inattention, or/and hyperactivity, together with significant and pervasive functional impairment (Miller & Thompson, 2013). ADHD is among the most extensively treated disorders in the adolescent and child psychiatry field, with about 5-10% of adolescents and children diagnosed with ADHD globally.

According to the research about 6.4 million children aged between 4 and 18 years have been diagnosed with ADHD in the United States. The data also demonstrates that boys are three times more affected by ADHD than girls (Ahmann, Saviet & Tuttle, 2017). ADHD is a mental condition that interferes with child’s intellectual ability, resulting to low academic achievements. A child suffering from ADHD records lower grade point average (GPA), low rates of college and high school graduation. This generally ends up affecting their entire life (Kellow, Holm & Fallesen, 2018).

Based on these statistics, it is considerably important for parents with children suffering from this condition to identify the best treatment methods to handle the condition, to improve quality of life of their children. The two main methods of treating ADHD include the use of pharmaceutical and the use of non-pharmaceutical techniques which include therapy. This paper proposes that non- pharmaceutical ADHD treatment methods are more effective than pharmaceutical treatment techniques.

ADHD Effect

Untreated behavioral issues might significantly impair the educational achievement and learning ability of children. Past researches have established that on average children with ADHD attain 2.2. to 2.5 years less schooling compared to non-ADHD age mates. In addition, about 25% of teenagers with ADHD do not complete their high school education. Both attention deficits and externalizing behaviors have been found to contribute to lower academic achievement (Kellow, Holm & Fallesen, 2018).

Children suffering from ADHD also demonstrate higher academic impairment, lower test scores, and lower cognitive attainments. The research consistently demonstrates that ADHD impacts different education results ranging from school behavior to achievement and performance measures (Hinshaw & Scheffler, 2014). ADHD is thus, a condition that requires early diagnosis and intervention plan to prevent sever damages on the life of the affected people.

ADHD Treatment

ADHD can be treated by use of non-pharmacological intervention method, pharmacological intervention method or a combination of the two, a method that is commonly regarded as pharmacotherapy. Different people different prefer different methods of ADHD treatment based on their beliefs or past experience. Pharmacological treatments are preferred since they act faster.

Psychosocial treatments are preferred due to creation of permanent changes and lack of side effects.  Other may consider using a combination of both for more improved outcomes. According to Tamm et al. (2017), both behavioral and pharmacological intervention measures are effective in improving the symptoms of ADHD and ADHD-associated impairments but at a different rate and different rate of side effect. However, their combination may result to more improved outcome than when used independently.

Pharmacological Intervention

Pharmacological intervention techniques involve the use of prescribed medication to treat or suppress the symptoms of ADHD. Different kind of medication can be used based on severity of individual condition, or based on body medical interaction of a person with commonly used medication. Pharmacological measures can also be used to suppress symptoms so as to give room for non-pharmacological measures. However, they are mostly recommended in a severe condition of ADHD.

According to Bown, Samuel and Patel (2018), the use of pharmacological measures to treat ADHD has been established to be positively related to enhancement of academic attainment in children in elementary stage, enhanced health-associated life quality in adolescents and children, and brain dysfunction improvement.

Some of the medications used in ADHD treatments include stimulants and non-stimulants. Stimulants refer to medications whose action mechanism is to enhance prefrontal cortex arousal. Medications such as amphetamine and methylphenidate act to boost neurotransmission dopamine and norepinephrine in the prefrontal cortex (Bown, Samuel & Patel, 2018).

Their general mechanism matches the general mechanism of illegal stimulants drugs. They can thus result to similar side effects as illegal stimulants which include elevation of systemic blood pressure and heart rate. Moreover, just like other stimulants, the medications have the addiction aspect, such that they can easily be abused by adolescence using them for ADHD treatment (Breggin, 2002). Although the heart rate and blood pressure arousal may be manageable in normal prescription, the condition may worsen in a situation where these medications are abused.

Stimulants act as the basic pharmacological intervention for ADHD patients.  Although they are associated with high level of symptomatic improvement, many caregivers do not prefer them, mostly due to stimulants addiction and abuse possibility of the ADHD pharmacological first-line agents and need for constant monitoring of the adolescent users to prevent cases of addiction. The use of pharmacological treatment may simply result to introduction of a new comorbid condition of drug addiction, if effective monitoring is not done.

ADHD pharmacological treatment can also be done by used of non-stimulants medications that include atomoxetine. Atomoxetine refers to a discriminating inhibitor of norepinephrine reuptake that results to increased dopamine and norepinephrine concentrations, in prefrontal cortex (Bown, Samuel & Patel, 2018). This medication lack addiction ability, though its initial response to the ADHD symptoms might be slower compared to stimulants medications, and hence it may be ineffective where quick response is required. Another challenge is that some of non-stimulants such as atomoxetine may cause other serious side effects such as behavioral and mood changes increasing potential for self-harm or suicide.

In general, pharmacological therapy is characterized by a number of side effects some that may be highly severe. They always create a need to manage other behavioral condition of the patient, other than the initial ADHD. In addition to this, they are likely to cause medical adversaries to some patients, where the patient develops allergic reaction towards ascertain medication, either after a short or length use. Patients may also develop resistance to a certain medication, and create the need to use strong stimulants to manage ADHD symptoms. This analysis portrays the negative outcome of pharmacological treatment, ruling it out as the best method to address ADHD condition in children and adolescents.

Non-Pharmacological Treatments

Non-pharmacological intervention techniques include behavioral therapy among other psychosocial therapeutic methods. Behavior therapy refers to wide set of unique interventions which contain a common objective of modifying social and physical environment to change or alter behavior. Behavior therapy assists children to learn to control their own behaviors much better. This ability to control behavior results to enhance functioning in relationships, at home and at school.

Practicing and learning new behavior needs effort and time. However, it has lasting advantages to the child with ADHD.  According to Ahmann, Saviet and Tuttle (2017), there are different evidence based behavior therapies targeting children at different age.  For instance, four evidence-based intervention programs have been identified for preschool children, some targeting teenagers and some targeting parents of children with ADHD. The research has also proposed advantages of multimodal interventions that depend on conditioning and skills building, development of planning skills and academic organization, intensive summer-camp treatment, and social skills training.

Psychosocial treatments include skills training, cognitive behavioral, and behavioral techniques. Psychosocial treatments are also related to more improvement in organizational and academic skills that include use of planner and homework completion. The main challenge of these approaches is that they show small to medium range improvements for ADHD symptoms or interpersonal functioning and behavioral symptoms.

Unlike the use of stimulants where ADHD symptoms are surpassed easily, one may need to invest in a lot in practicing before the child adapts to a new behavior and learns how to effectively apply it. Most psychologists have adapted to coaching as a way of enhancing behavioral changes in children with ADHD. Coaching can be provided to an individual, a group, physically or using videos.

The type of coaching may vary effectively based on the main objective of these sessions, which is mostly influenced by the child’s age and the severity of the condition. Although the psychosocial intervention means are considerably hard and tedious, the final results bring permanent change to the child with ADHD. They thus play an essential role in improving quality of life of a child with ADHD. Unlike pharmacological treatment, psychosocial therapy does not have any side effects.

Another non-pharmacological method of addressing ADHD is the use of diet. According to Rytter et al. (2015), dietary change methods that can be used to treat ADHD include elimination diets that remove some elements from the diet, or additional diet where intake of some nutrients is added to control ADHD symptoms. Elimination diet is founded on the notion that some children might some children might experience behavioral changes when subjected to some food items, especially artificial additive foods. Food such as artificial sweeteners and sugar are said to make some children hyperactive. Increase intake in a diet is based on the notion that a child behavior could be influenced by lack of some nutrients.

This intervention measure focuses more on amino acids since it is used in the synthesis of norepinephrine, monoaminergic neurotransmitters, serotonin, and dopamine that are engaged in the ADHD symptoms. Therefore, amino acids supplements may assist children with ADHD. Other additives would include essential fatty acids, vitamins, especially vitamin B compounds, and minerals such as magnesium, iron and zinc (Rytter et al., 2015). Diet management can thus result to effective management of ADHD symptoms. The main advantage of diet intervention measure is that it is cheap and does not demonstrate any side effects. In addition, dietary intervention seems to act faster than the behavior therapy, and hence it can be used to supplement medications, without major side effects.


Based on the above analysis, there are different techniques to treat ADHD and thus, different psychiatrists may prefer different measures of treating ADHD. The analysis clearly shows negative impact of pharmacological treatment. Although it acts much faster in suppressing the symptoms, it present negatives side effects that are hard to handle. This makes non-pharmacological treatment more reliable in making permanent changes without worrying about side effects.

Actually, a combination of different non-pharmacological treatment for instance dietary treatment and behavior therapy are likely to result to more improved results than applying pharmacological treatment alone. An integration of the pharmacological and non-pharmacological interventions may also results to more reliable outcome. However, this approach may also subject patients to serious pharmacological side effect. This proves that non-pharmacological ADHD interventions are more safe and reliable in treating ADHD compared to pharmacological ADHD treatment methods.




Ahmann, E., Saviet, M., & Tuttle, L. J. (2017). Interventions for ADHD in children and teens: A focus on ADHD coaching. Pediatric Nursing, 43(3), 121-131.

Breggin, P. R. (2002). The Ritalin fact book: What your doctor won’t tell you about ADHD and stimulant drugs. Cambridge, MA: Perseus.

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners.  Transl Pediatr, 7(1), 36-47.

Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: myths, medication, money, and today’s push for performance. Oxford: Oxford University Press

Keilow, M., Holm, A., & Fallesen, P. (2018).Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PLoS ONE, 13(11), 1-18.

Miller, N. J., & Thompson, R. (2013). ADHD: cognitive symptoms, genetics and treatment outcomes. New York, NY: Nova Science Pub Inc.

Rytter, M. J. H., Andersen, L. B. B., Houmann, T., BIlenberg, N., Hvolby, A., Molgaard, C., Michaelsen, K. F., & Lauritzen, L. (2015). Diet in the treatment of ADHD in children – a systematic review of the literature. Nord J Psychiatry, 69, 1-18.

Tamm, L., Epstein, J. N., Taylor, H., Bukstein, O., Koshy, A., Maltinsky, J.………… & Vaughn, A. (2017). Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial. American Psychological Association, 85(5), 434-446.