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Nursing: Health Education and Improving Patient Self-Management

This chapter focuses on health. It is about how you can defne health and what views on health are important. Because what is health anyway? There are a number of visions of health. The World Health Organization (WHO) defned health and took this as a starting point for its health policy. Various viewpoints give you the opportunity to formulate your own vision of health. Your own vision of health determines your vision of your professional nursing practice. Your vision of health is the foundation of your nursing care. This chapter also deals with how to measure health. We are going to look at the principles of epidemiology. Health indicators show you how “healthy” the population is. Health indicators give you a clear view of important health problems and of public health. For nursing professionals, an insight into the state of health of people is the starting point for prevention and targeted care. In this chapter we answer the question: what is health? We describe in Sect. 1 the different views on health: the medical, monocausal vision, the biological vision, the psychological and social visions, the humane, multicausal vision, and the dynamic vision. We also address the International Classifcation of Functioning, Disability, and Health (ICF). After this, we all look at important health indicators (among others, mortality, life expectancy, quality-adjusted life-years (QALYs) and disability- adjusted life-years (DALYs), morbidity, multimorbidity, and health differences), to see inside public health.

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Post-Prostatectomy Incontinence

Prostate cancer is the most frequently diagnosed malignancy in men, with an estimated 220,800 new diagnoses in the United States in 2015 . Approximately 40% of men with localized prostate cancer elect to undergo radical prostatectomy . While stress urinary incontinence (SUI) is almost universally evident immediately following prostatectomy, the severity and degree of recovery are variable. Reported rates of persistent and bothersome urinary leakage following prostatectomy, or post-prostatectomy incontinence (PPI), range anywhere from 5 to 72% , though this variability is largely due to the absence of a strict defnition for PPI. With the emergence of minimally invasive technologies, robotic approaches to performing prostatectomy have become widely popularized. PPI nonetheless remains an issue, with a reported incidence of 4–31% in robotic cases, versus 7–40% in open cases . Other series have reported PPI rates of <10% after robotic prostatectomy, with improvement seen over the frst 24 months following surgery . Although refnement in surgical techniques has helped reduce the incidence of PPI , the overall prevalence continues to rise due to an increase in the total number of prostatectomies performed worldwide.

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Transcatheter Paravalvular Leak Closure

Paravalvular leak (PVL) is a common complication after surgical valve replacement, with reported incidences at follow-up varying from 2% to 17% in both mitral and aortic positions . Among patients in whom PVL develops after surgery, approximately 3% require reoperations because of heart failure, hemolysis, or a combination of both . Surgical reoperation is the standard treatment for symptomatic PVLs . It has been demonstrated that in symptomatic patients with PVL, surgical treatment is associated with improved survival compared with conservative management . However, redo surgery is often associated with high morbidity and mortality: several series report an acute mortality between 6% and 22% after surgical reoperation for PVL . Increased risk was observed in severely symptomatic patients (NYHA asses III–IV and severe hemolysis) and in patients with multiple surgical reinterventions. Associated co-pathologies could further increase operative risk.

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Trajectory Analysis in Health Care

All events in the universe involve energy potential differences. Whether it is the flow of light photons and other electromagnetic energy from the sun through the solar system, a lightning bolt, the bioenergetic proton motive force across the dynamic mitochondrial inner membranes within our cells, or interactions between individuals, energy potential differences drive the creation of order. This phenomenon exists in all health conditions, good and bad, even though it is rarely recognized. This failure too often comes from the rigid silos of academic hubris even when there is considerable consilience between all areas of knowledge. In this volume, we explore these applications for epidemiology and health care. This phenomenon of energy potentials across all aspects of living and nonliving systems at many orders of magnitude merits its place not as an anomaly but as a basic physical principle. In their book on scale invariance in phase transitions , Lesne and Laguës (2012) cited Pierre Curie’s 1895 doctoral thesis, in which Curie keenly observed that, comparing the magnetic state of a metal to the density of an ordinary fluid, the intensity of magnetization I is proportional to density D, and magnetic field strength H is proportional to pressure P: (1.1) While this relationship remains poorly explained, scientists such as Rene Thom (1972) attempted to understand similarity in patterns across seemingly unrelated processes: a topology of reality. Such similarities rely strongly on basic physical processes that operate on multiple levels. Furthermore, whereas such processes can be measured with high precision in molecules, cells, and tissues, they are far more difficultto evaluate in thinking beings and in dynamic, complex social systems.

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Translational Anatomy and Cell Biology of Autism Spectrum Disorder

Autism spectrum disorder (ASD) describes a group of neurodevelopmental conditions clinically characterised by impaired social interaction and communication and the presence of restricted interests and stereotyped and repetitive behaviours (Kanner 1943; Asperger 1944; Coleman and Gillberg 2012). Epidemiological studies estimate that more than 1% of the general population could receive a diagnosis of ASD (Elsabbagh et al. 2012; Developmental Disabilities Monitoring Network Surveillance Year Principal 2014). Individuals with ASD can also suffer from comorbidities including intellectual disability (ID), developmental delay (DD), epilepsy, motor control difficulties, attention deficit hyperactivity disorder (ADHD), tics, anxiety, sleep disorders, depression, dysmorphic features or gastrointestinal problems (Gillberg 2010; Moreno-De-Luca et al. 2013). The term ESSENCE for ‘Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations’ was coined by Christopher Gillberg to take into account this clinical heterogeneity and syndrome overlap (Gillberg 2010). There are 4–8 times more males diagnosed with ASD than females (Elsabbagh et al. 2012), but the sex ratio is more balanced in ASD patients with ID and/or dysmorphic features (Miles et al. 2005).

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Pharmacology of Mitochondria

Noncanonical functions of several nuclear transcription factors in the mitochondria have been gaining exceptional traction over the years. These transcription factors include nuclear hormone receptors like estrogen, glucocorticoid, and thyroid hormone receptors: p53, IRF3, STAT3, STAT5, CREB, NF-kB, and MEF-2D.

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Optimizing Outcomes for Liver and Pancreas Surgery

In the United States, as the large baby boomer population cohort continues to age, the number of patients presenting with hepatopancreatobiliary (HPB) malignancies has and will continue to rise into the foreseeable future. The US Census Bureau projects that the number of adults aged 65 and older is expected to increase from 46 million in 2014, to 74 million by 2030 . The median age for cancer diagnosis is 66 years, making advanced age an increased risk factor for development of HPB carcinomas . In agreement, cancer incidences for both liver and pancreatic cancers are expected to increase from 2010 to 2030 by 59% (liver) and 55% (pancreas), respectively . Thus, in the upcoming decades, substantial healthcare resources and attention will be devoted to treating HPB malignancies. Surgical resection continues to remain the preferred curative treatment option for HPB neoplasms. However, older patients with HPB disease are often frail and have multiple comorbidities alongside their primary malignancy, thus making aggressive surgical resections high risk for these patients. For frail and elderly patients undergoing elective procedures, perioperative care must be afforded special attention in order to decrease incidences of severe morbidity and mortality. While postoperative care is a mainstay of focus for surgical patients, preoperative assessment is often afforded less attention within the feld of HPB surgery. By the use of standardized patient assessments, clinicians are able to obtain a more accurate representation of a patient’s true health status, thus making it possible to identify surgical patient populations with higher risks of postoperative morbidity, mortality, increased length of hospital stay, and increased risk of being discharged to skilled nursing facilities.

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Pediatric Electromyography

In constructing a historical context in which to view the discipline of electrodiagnostic medicine, it is diffcult to determine a logical starting point. It is an elementary argument to assert that the biological underpinnings of the discipline date easily back to Galvani and Volta in the eighteenth century. Although these scientifc pioneers played seminal roles in characterizing the role of electricity in the function of muscle and nervous tissue, some would credit even earlier observers with reporting the phenomenology that Galvani characterized as “the energy of life”. Ultimately, it is the translational process of applying fundamental biological principles to the investigation of human disease, which has permitted the evolution of our discipline. Admitting a large measure of arbitrariness reinforced by a limited historical perspective of the scientifc zeitgeist of successive eras of neurobiologists, I have cobbled together a decidedly imperfect, but well intentioned, snapshot of the conceptual ontogeny of electrodiagnostic medicine and its adaptation to pediatrics. I should apologize to bioengineers who will note that I have given short shrift to the technical aspects of the development of clinical electrophysiology. The evolution of our discipline has not been predominantly hypothesis driven but rather has been a captive of technology and has grown at a logarithmic pace as new methodologies have been adapted to investigate human neuromuscular physiology. Let me add one further disclaimer; I have not attempted to acknowledge the role of individual contributions to the body of knowledge but rather the evolution of our ongoing integration of basic scientifc information into the understanding of the biological substrate of neuromuscular disease.

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Onychomycosis

From a clinical perspective, nails are simply specialized keratin structures on the dorsal surfaces of our fngers and toes. To the average person, however, they represent so much more. Nails are protective, useful for grasping fne objects, perfect for scratching itches, and important to an individual’s overall appearance: people spend time cutting, fling, and sometimes decorating them in order to look “presentable .”Understanding that, it’s easy to see how diseases of the nail can have substantial physical and psychosocial consequences Indeed, individuals with nail dystrophies often suffer from considerable pain and discomfort, can have diffculty walking, and are at risk for signifcant complications, including bacterial superinfection and cellulitis . Moreover, recent studies have shown that those afflicted with certain nail dystrophies are often shunned in their personal and professional lives due to the unsightly disfgurement . Although there are a variety of disorders (both cutaneous and systemic) that can affect the nails, more than half of all nail dystrophies are caused by fungal infections (onychomycosis) . Unfortunately, fungal nail infections are often diffcult to defnitively diagnose, as many nail disorders (fungal and non-fungal alike) have the potential to cause a wide variety of nail abnormalities. Consequently, any given abnormality may be the manifestation of various diseases. Therefore, it’s important that any clinical suspicion of onychomycosis be confrmed with laboratory testing. Additionally, there are many species of fungi that can invade the nails and multiple mechanisms of fungal invasion, both of which can contribute to the clinical presentation .

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Orofacial Disorders

Leukoplakia is primarily a clinical term for a predominantly white lesion that cannot be wiped off and that cannot be characterized as any other defnable white lesion of the oral mucosa. It is the most common premalignant lesion of the oral mucosa. A premalignant or potentially malignant lesion is a lesion that carries a signifcantly increased risk of transforming into cancer. Some prefer to refer to leukoplakia as a disorder instead of a lesion since cancer development may not only occur in or adjacent to the leukoplakic area but also elsewhere in the oral cavity or the headand-neck region.

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