A physician-hospital organization (PHO) consists of 15 hospitals – with 2,247 staffed beds – and approximately 500 physicians. The PHO operates in a very large section of south Georgia, including the cities of Valdosta, Tifton, Thomasville, Moultrie, and Waycross. The PHOs’ physician members represent approximately 90 percent of all physicians practicing in the region.

The PHO served as a vehicle through which competing hospitals and physicians could bargain collectively with health plans to obtain higher fees for themselves. The owner PHOs, member hospitals, and member physicians canceled contracts with payors and informed them that the PHO would be the sole entity through which they would enter into payor contracts. To contract with the PHO, payors allegedly have had to accept the fixed physician fee schedule and fixed discount of no more than 10 percent off hospital list prices.

1. Explain why this arrangement would be found “per se” illegal under the FTCs’ analysis.
2. What kind of actions could be taken to restructure this arrangement to avoid a determination that it is per se illegal?
3. Discuss the alternate FTC analysis that is applied to such cases if they are suspect but not found to be per se illegal.

1. Limit your responses to a maximum of three pages, not including title and reference pages.
2. Be sure to utilize at least 3-4 scholarly references to support your discussions.
3. Be sure to properly cite your references within the text of your assignment and listed at the end

Case Study 3 & 4: Inflammatory Bowel Disease and Urinary Obstruction.

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle. Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program). Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words.

The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submited in this course are registered and saved in turn it in program.

All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites) per case Study

Inflammatory Bowel Disease Case Study

The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness.

Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)

120 min: 6 mg/dL (normal: >20 mg/dL)

Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine

Diagnostic Analysis

The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well.

Critical Thinking Questions

1. Why was this patient placed on immunosuppressive therapy?

2. Why was the Meckel scan ordered for this patient?

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards)

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?

Urinary Obstruction case study

The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft.

Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle Normal resting bladder with a positive tonus limb Cystoscopy Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL) Prostate ultrasound Diffusely enlarged prostate; no localized tumor

Diagnostic Analysis

Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems.

Critical Thinking Questions

1. Does BPH predispose this patient to cancer?

2. Why are patients with BPH at increased risk for urinary tract infections?

3. What would you expect the patient’s PSA level to be after surgery?

4. What is the recommended screening guidelines and treatment for BPH?

5. What are some alternative treatments / natural homeopathic options for treatment?

Write a paper addressing the following questions (provide citations to references used): 

1. Is individual access to health care a right or a privilege? Consider the financial implications of your response. What are the additional responsibilities of the client, the nurse and the overall healthcare system based on your stance?

2. Compare the cost of Healthcare in the U.S. considering the specific approaches of health promotion, disease prevention, and chronic disease management.

a. Identify which approach is the most cost effective.

b. How can nursing practice impact the cost in each category?

3. What, in your opinion, are the current U.S. Health Care System design shortfalls, if any? How would you re-design the system to promote the approaches of health promotion, disease prevention, and chronic disease management?

4. Think about your future nursing practice. How can you use your nursing knowledge to champion health promotion, disease prevention, and chronic disease management?

5. Finally, recall the essential themes in the latest Institute of Medicine’s Report on the Future of Nursing? Reflect on how your knowledge/views/opinions have changed or remain the same since starting your education at Nightingale College.

Please make sure you follow the attached rubric. 

Rubric

The Future of Nursing and Healthcare Assignment

 

The Future of Nursing    and Healthcare Assignment

 

Criteria

Ratings

Pts

 

This criterion is   linked to a Learning OutcomeThis Criterion is linked to a Learning Outcome   Analytical and Cognitive Skills

 

30.0 pts

Learner     Demonstrates understanding of content. In-text citations are present, but     there is less than 10% cited, the work is the learner’s own and not cited     or paraphrased material.

20.0 pts

Learner     understands most of the content. In-text citations are present but no more     than 20% is cited; and the majority of the work is the learner’s own

10.0 pts

Learner has     in-text citations, but less than 30% is cited. There is some content copied     and pasted from outside sources.

5.0 pts

Learner has     in-text citations, but less than 40% is cited. There is some content copied     and pasted from outside source.

0.0 pts

Work is unoriginal     and 40% or more is copied & pasted from outside resources.

30.0 pts

 

This criterion is   linked to a Learning OutcomeThis Criterion is linked to a Learning Outcome   Quality of Posts

 

10.0 pts

Thorough use of     key terms and concepts relevant to the assignment. Thoroughly incorporates     readings and other academic & professional resources

6.0 pts

Correct use of key     terms and concepts relevant to the assignment. Correctly incorporates     readings and other academic & professional resources.

4.0 pts

Minimal use of key     terms and concepts relevant to the assignment. Minimally incorporates     readings and other academic & professional resources

0.0 pts

No knowledge of     the key terms and concepts relevant to the assignment. No use of readings     or academic & professional resources.

10.0 pts

 

This criterion is   linked to a Learning OutcomeThis criterion is linked to a Learning Outcome   Addresses all questions

 

20.0 pts

Thoroughly and     substantively addresses all 5 questions.

15.0 pts

Thoroughly and     substantively addresses most of the questions.

5.0 pts

Addresses all     questions

0.0 pts

Does not address     the questions.

20.0 pts

 

This criterion is   linked to a Learning OutcomeThis criterion is linked to a Learning Outcome   Grammar and Spelling

 

10.0 pts

No Grammar or     Spelling Errors

5.0 pts

Less than 5     grammar or spelling errors

2.0 pts

More than 5 but     less than 10 grammar or spelling errors

0.0 pts

More than 10     grammar or spelling errors

10.0 pts

 

This criterion is   linked to a Learning OutcomeThis criterion is linked to a Learning Outcome   Evidence

 

10.0 pts

Provides     references to at least 5 scholarly sources (textbook, journal articles,     articles, etc.)

5.0 pts

Provides     references to less than 5 scholarly sources.

0.0 pts

No references     provided.

10.0 pts

 

This criterion is   linked to a Learning OutcomeThis criterion is linked to a Learning Outcome   Timeliness

 

20.0 pts

Assignment is on     time or early.

15.0 pts

Assignment is less     than 24 hours late.

10.0 pts

Assignment is less     than 48 hours late.

5.0 pts

Assignment is less     than 72 hours late.

0.0 pts

Assignment is     greater than 72 hours late.

20.0 pts

 

Total   Points: 100.0

Purpose

The purpose of the iCARE Paper assignment is to explore the concept of interprofessional teams and patient outcomes. Nursing supportive actions of compassion, advocacy, resilience, and evidence-based practice will serve as a way to apply care concepts.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO1: Applies principles of nursing, theories, and the care philosophies to self, colleagues, individuals, families, aggregates and communities throughout the healthcare system. (PO#1)

CO6: Plans clinical practice activities that integrate professional nursing standards in accordance with the Nursing Code of Ethics and the American Nurses’ Association (ANA) standards of practice. (PO#6)

Points

The assignment is worth 200 points.

Due Date

Submit your completed assignment by Sunday end of Week 5 by 11:59 p.m. MT.

Directions

Getting Started: Interprofessional teams are part of practice trends we see developing in all aspects of care delivery. Consider you own work environment (or recent clinical setting).

· For this assignment, consider the concept of interprofessional teamwork and patient outcomes.

· Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.)

· Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)

· iCARE components are:

C ompassion

A dvocacy

R esilience

E vidence-Based Practice (EBP)

· How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?

· Select one scholarly nursing article from CINAHL as a resource for your paper. Additional scholarly sources can be used but are optional.

· Use APA format throughout, particularly in citations and on the References page.

· Please paraphrase throughout. One short quote is permitted.

· The prepared paper template is RECOMMENDED for this assignment.

Download the assignment template here: iCare Assignment Template (Links to an external site.)Links to an external site.

A short tutorial with tips for completing this assignment may be viewed here: iCARE Paper (Links to an external site.)Links to an external site.

Elements of iCARE paper

· Title page

· Below are the headings to be used for this assignment. 

· Introduction: (No heading needed here in APA) Explain the type of work setting you are discussing and whether interprofessional teams are currently present. If interprofessional teams are present, indicate a team function that could be improved. If interprofessional teams are NOT present, indicate what type of team you think might be possible in the setting.

Describe a nursing action item for each component below that could contribute to: interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.

· Compassion

· Advocacy

· Resilience

· Evidence-Based Practice

· Summary: Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes. Address how you may be able to influence this process of support for interprofessional teams overall in your unit or organization.

· References page: List any references used in APA format.

**Academic Integrity Reminder**

College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment. Please see the grading criteria and rubrics on this page.

Please see the grading criteria and rubrics on this page.

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