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Evaluation and Management of Patients with Cardio-Pulmonary DiseasesThe topic of this dissertation is the evaluation and management of patients with cardio-pulmonary diseases. During an eighteen (18)-month period, the researcher will design, implement, and evaluate the bronchoscopy cost reduction program for cardio-pulmonary disease patients in a hospital in Southern California. This section presents a review of related literature and an annotated bibliography.In the following review of literature, there are several points of discussion that may stand out. Of these points, I would like to discuss two. The first is the quality of the health care services received by the patient, especially in bronchoscopy and the second is the standards of quality of health care service received by the patient.

A cheaper option does not necessarily mean lower quality. In fact, in the study of Waddington, et. al. (2004), they explored the use of high resolution imaging in diagnosing possible cardiopulmonary diseases. Such an option, however, entails higher cost and might not be the choice of the patient. In this regard, all the possible options for diagnosis and treatment will be presented to the patient so that he will have a clearer idea of what to expect from the diagnosis and treatment. If the patient chooses a lower-cost alternative, which is what the research project seeks to promote, the standards of quality should not be compromised.In relation to this, Davis, Schoenbaum, & Audet (2005) provided a set of seven guidelines that will help ensure that such standards of quality are provided to the client.

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This falls under the patient-centered health care framework, which the trio of researchers are espousing. This patient-centered health care framework will therefore be considered in any initiatives reducing the costs of bronchoscopy. The researcher, during the 18-month period of research, will undertake careful consideration of all available options for bronchoscopy, as well as with the costs associated with them. These options will then be put under the framework of patient-centered delivery of health care services in which the welfare of the patient takes center stage.Wilcock, A.

, Crosby, V., Hughes, A., Fielding, K., Corcoran, R. & Tattersfield, A. E. (2002).

Descriptors of Breathlessness in Patients With Cancer and Other Cardiorespiratory Diseases. Journal of Pain and Symptom Management, 23 (3), 182-189.Patients with cardio-pulmonary diseases have their needs for treatment, as well as for emotional and psychological support.

Hence, it would be necessary to provide a profile of these patients and outline their own needs. The effects of cardiopulmonary diseases on patients are well-known. It involves breathlessness or difficulty in breathing as well as the inability to engage in strenuous physical activities for a long period of time among others.

Since breathlessness is an accompanying symptom of cardiopulmonary diseases, it would be important to analyze this breathlessness and establish the cause of such breathlessness. Wilcock, et. al. (2002) conducted a study that sought to analyze the causes of breathlessness.

Wilcock’s team investigated the different descriptors of breathlessness and the causes behind these in patients who had lung cancer and cardiopulmonary diseases. They wanted to test if the descriptors were reliable in predicting the kind of diseases being felt by patients. Their research studied a total of 131 patients whose breathlessness was ascribed to tumor mass, mestases, pleural thickening and lung collapse. On the other hand, the breathlessness of 130 patients was ascribed to asthma, pulmonary disease or chronic pulmonary disease or cardiac failure. The patients had a 15-item questionnaire containing the descriptors.

Although there were qualitative differences in the nature of the breathlessness reported by patients, it was difficult for the researchers to truly differentiate among these kinds of breathlessness. As such, their questionnaire would not be able to aid the medical practitioner fully as to the kind of breathlessness that corresponds to different kinds of cardiopulmonary diseases.The kinds of descriptors described by Wilcock, et. al.

(2002) will be helpful for this study and will help the researcher asses the kinds of breathlessness experienced by patients with cardiopulmonary diseases. These descriptors, however, need to be counter-checked with other means of research so that it will become more reliable. Their approach of establishing descriptors for the study may also be helpful for the methodology of this study.Wahidi, M. W. & Ernst, A (2005). Role of the Interventional Pulmonologist in the Intensive Care Unit. Journal of Intensive Care Medicine, 20 (3), 141-146.

Interventional Pulmonology is a relatively young discipline in the critical care medicine. Its focus is on the diagnosis and modalities in airways in pleural disorders. In intensive care units (ICU), the pulmonologist can perform a significant job in providing important advice and assistance in the administration of cures and operations in patients suffering from respiratory difficulties. Through the efforts of the pulmonologist, the patient in the ICU will be able to enjoy a greater level of medical care (Wahidi & Ernst, 2005).The role of the pulmonologist becomes even more pronounced in the area of bronchoscopy.

Bronchoscopy allows the doctor to look at a person’s airways, throat, trachea and larynx through an instrument called bronchoscope. This process is undertaken in order to perform a diagnosis of diseases involving the airway or to remove any object or growth trapped in the airway. Flexible bronchoscope usually does not make use of general anesthesia and is more comfortable as compared with rigid bronchoscopy. The former is better suited for smaller airways and helps the doctor remove small samples of tissue without inducing great pain (WebMD, 2007).

Rigid bronchoscope, on the other hand, uses a hollow metal tube, which is usually used in cases where there is bleeding in the airways. This is also employed in removing large tissue samples and in cleaning the airways. In some instances, bronchoscopy is also used to stop bleeding in the airway of a person (WebMD, 2007).

In addition to this, bronchoscopy is now used extensively to analyze the extent of lung cancer. Hence, it is a very useful tool for doctors in diagnosing patients with cardiopulmonary diseases.Waddington, T.

W., Brenner, M., Colt, H., Guo, S., Chen, Z., & Armstrong, J. (2004).

Human Bronchoscopy with High Resolution Imaging. Chest, 126 (4), 708 -715.Waddington, et. al.

((2004) conducted a study exploring the different advances in the technology of diagnosing malignant airways. The researchers noted that Optical Coherence Tomography (OCT) is a medical technology that is fast developing and helping generate high-resolution cross-sectional images very close to the level of histology and this is done at real time.Waddington and his team examined the images of areas that are suspected to be infected with a cardiopulmonary disease made using flexible fiberoptic bronchoscopic imaging.

This imaging was done using the Lung Imaging Fluorescene Endoscopy (LIFE). The authors found out that LIFE generated images with high resolution, which were then compared with the product of OCT and traditional bronchoscopic images. Based on the comparisons made, OCT made images that differentiate several microstructures in glands, carthilage, epithelium and mucosa (Waddington, et. al. 2004).The study of Waddington, et. al (2004) is the first of its kind in showing that high resolution bronchoscopy may be done as guided by the technology of LIFE. This kind of study shows that high resolution OCT may be integrated with fiberoptic bronchoscopy and the technology of LIFE.

The result is better diagnosis and detection of the occurrence and incidence of diseases in the airways, which can point out to different kinds of cardiopulmonary diseases.This integration of various technologies and methods in detecting cardiopulmonary diseases would help provide additional insights into the nature of these diseases in the future. However, since this is a state of the art technology, the cost would still be great, so one important question would be how to make these kinds of diagnostic tools more accessible to people and less costly. If more people had access to this kind of technology, the incidence and occurrence of cardiopulmonary diseases will be curbed and the health of people will be greatly enhanced.

Pauwels, R. A. & Rabe, K. F.

(2004). Burden and clinical features of chronic obstructive pulmonary disease (COPD). The Lancet, 364 (9434), 613-620.Pauwels & Rabe (2004), on the other hand, explored chronic obstructive pulmonary disease (CPOD), which is the main cause of mortality and morbidity all over the world. As such, it has become an important social and economic burden for people all over the world. In fact, it is the fifth leading cause of death in the world. More often than not, this disease is neither diagnosed nor treated very much by health care practitioners. There are a number of risks for the progression of this disease, which develops early in life contrary to popular beliefs.

These risks include tobacco smoking and other pulmonary diseases. Stopping smoking is an effective means of hampering the progress of this disease yet the lungs, if they have been damaged already, might still make the progress of the disease. Knowledge of this disease will also contribute to a better understanding of cardiopulmonary diseases.CPOD is but one of the many cardiopulmonary diseases proliferating in the society today. Yet, if a good understanding of this disease is established, then diagnosis and intervention would be done in a much better way and will contribute to the alleviation of the sufferings of those who are infected with this disease.Also, the detection of CPOD is one of the applications of bronchoscopy. This study can make use of an understanding of CPOD in looking at other functions and uses of bronchoscopy. Patients with CPOD can therefore opt to avail of bronchoscopy as one of the means of detecting and eventually intervening with the progress of the said diseases.

Selecky, P. A., Eliasson, A. H., Hall. R. L., Schneider, R.

F., Varkey, B. & McCaffree, D. R. (2005). Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases.

Chest, 128, 3599-3610.In some cases, because of the acuteness of the disease, doctors have to recourse but to give palliative care to patients. Palliative care refers to the prevention, inducement of relief, or soothing the symptoms of a disease in the intent of easing suffering in the patient. Although used to ease the suffering of dying patients, the use of palliative medicine is not restricted to this purpose (Selecky, et. al, 2005).

Because of the seriousness of this kind of treatment, the family of the patient should be consulted and be part of the treatment process even under the care of licensed and competent physicians (Selecky, et. al, 2005). The involvement of the family of the patient is important, not only in the case of the dying or highly dangerous diseases. Even in the case of cardiopulmonary diseases, the role of the family in comforting the patient and helping him take medicines and implement other treatment procedures cannot be discounted.

The study of Selecky gives importance to the role of the family and the relatives of the patient in deciding the best option for treatment and for the medication of the patient. In exploring cheaper options for diagnosis and intervention, the family of patients should be made aware of the options available, together with the implications of these options to the patient.Health care is a public good and as much as possible, it should be made available to everyone in the society. However, because of economics, and the differences in the level of income of people, the kind of health care services available to them may vary enormously (Podgers, 2005).Rogowski, J., Freedman, V., & Schoeni, R. (2006).

Neighborhoods and the Health of the Elderly: Challenges in Using National Survey Data. Population Studies Center. Retrieved 7 October 2007 from http://globalag.igc.org/health/us/2006/neighborhood.

pdf.In response to this, the health care sector, and even medical practitioners cannot deny that they do have a social responsibility in the provision of health care services to the population. Although the government is allocating its resources toward this, it is still important, nonetheless, for private health care practitioners to contribute to these efforts.

Hence, making bronchoscopy more accessible through lesser cost would be greatly desirable in the early detection and intervention of cardiopulmonary diseases. Through this, treatment would be initiated earlier for people who do have the said kind of diseases and this would be at a more affordable cost.Rogowski, Freedman, & Schoeni (2006) argued that neighborhoods usually have an impact on the health of the elderly as well as on their access to health care services. This is especially true because some of the most debilitating diseases occur later in life. If the neighborhood is rife with pollutants in the air, water, and other domains, then the elderly people, together with the younger segments of the society are exposed to diseases and other infections. Considering the elderly would therefore be an important matter in the delivery of health care services to the whole population.Given this scenario in the lives of elderly and younger members of the population, the importance of the cost of the health care services may take central stage in their health. In neighborhood with a high incidence rate of cardiopulmonary diseases, a less costly bronchoscopy would therefore help them a great deal in dealing with such diseases.

Davis, K., Schoenbaum, S. C., & Audet, A. (2005). A 2020 vision of patient-centered primary care. Journal of General Internal Medicine, 20 (10), 953-957.

Even if cardiopulmonary health care services become less costly, the quality of the services received by the patients should not be compromised. In fact, the Institute of Medicine has included patient-centered care as one of the six aims of quality in the practice of health care services. Davis, Schoenbaum, and Audet (2005) explored seven dimensions of primary care that takes into account the situation of the patient. These attributes include (1) access to care, (2) the engagement of patient in care, (3) information systems, (4) coordination of health care, (5) integrated and comprehensive team care, (6) surveys of patients regarding the health care they received, and (7) publicly available information. These dimensions of patient-centered health care will be important in making bronchoscopy more readily available while at the same time ensuring that patients receive the level of health care that they deserve.Community Health Centers (CHC) would also benefit greatly from a less costly bronchoscopy. This would also help CHC to gain more favorable response from people who do have cardiopulmonary diseases. Health maintenance organizations (HMOs) are being used by more people yet if bronchoscopy became less costly, more people could have access to it and could detect possible cardiopulmonary infections that they may have (Shi, et.

al., 2003).Verheijde, J.

L. (2005). Managing Care: A Shared Responsibility. New York: Springer.In this book, Verheijde explores the Health Care sector and the way that health care is being provided to different sectors in the population. Through his illustrations and his explorations on the topic, he shows that there should be greater accessibility in the delivery of health care for Americans since the sector has not been fulfilling the expectations in the delivery of health care services.

The author also boldly takes a look at the concept of managed care and the relationship between government and the private sector in delivering health care services. By consulting this book, the researcher will have a better perspective as to the reason why health care, including bronchoscopy should become more accessible to different people in the United States.Vlahov, D.

& Galea, S. (2002). Urbanization, Urbanicity, and Health. Journal of Urban Health, 79 (1), S1-S12.Cities and urban places are on the rise all over the world and the process of urbanization is still on going. As such, the medical and health care needs of people in the cities will continue to rise.

Therefore, access to health care services becomes even more important in view of this greater density of populations. Since pollution can be found in the air and water of urban areas, it would be likely that cardiopulmonary infections may also increase.As urbanization increases, the health care needs of people can best be viewed through three areas. Making bronchoscopy more accessible to people in urban places would therefore be a great benefit for delivering health care services.

These are the social environment, the physical environment and the access of people to health and social services. This perspective will aid the researcher in looking at different factors that influence the level of access of people to health care. In establishing a strategy for making bronchoscopy less costly, these areas of concern will be considered.By consulting and drawing upon the findings of these books and journal articles, the researcher will be able to know what is going on in the field of bronchoscopy as well as the recent trends and technologies in addition to the strategies, methods, and findings of different researchers and authors.ReferenceDavis, K., Schoenbaum, S.

C., & Audet, A. (2005). A 2020 vision of patient-centered primary care. Journal of General Internal Medicine, 20 (10), 953-957.LeGrand, S. (2002). Dyspnea: the continuing challenge of palliative management.

Current Opinion in Oncology, 14 (4), 394-398.Pauwels, R. A.

& Rabe, K. F. (2004). Burden and clinical features of chronic obstructive pulmonary disease (COPD).

The Lancet, 364 (9434), 613-620.Podger, A. (2005). Directions for Health Reform in Australia. Paper Presented to the  Productivity Commission Roundtable on “Productive Reform in a Federal System”. Retrieved 7 October 2007 from http://www.newmatilda.com/admin/imagelibrary/images/txo0Rfe65LsO.

doc.Rogowski, J., Freedman, V., & Schoeni, R.

(2006). Neighborhoods and the Health of the Elderly: Challenges in Using National Survey Data.        Population Studies Center.

Retrieved 7 October 2007 from http://globalag.igc.org/health/us/2006/neighborhood.pdf.Selecky, P. A., Eliasson, A.

H., Hall. R. L., Schneider, R. F., Varkey, B.

& McCaffree, D. R. (2005). Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases. Chest, 128, 3599-3610.Shi, L., Starfield, B.

, Xu, J., Politzer, R. & Regan, J. (2003). Primary Care Quality: Community Health Center and Health Maintenance Organization. Southern Medical Journal, 96 (8), 787-795.Waddington, T.

W., Brenner, M., Colt, H.

, Guo, S., Chen, Z., & Armstrong, J.

(2004). Human Bronchoscopy with High Resolution Imaging. Chest, 126 (4), 708 -715.Wahidi, M. W. & Ernst, A (2005). Role of the Interventional Pulmonologist in the Intensive Care Unit.

Journal of Intensive Care Medicine, 20 (3), 141-146.WebMD (2007). Bronchoscopy. Retrieved 7 October 2007 from http://www.webmd.com/a-to-z-guides/Bronchoscopy-16978.Wilcock, A.

, Crosby, V., Hughes, A., Fielding, K., Corcoran, R. & Tattersfield, A. E.

(2002). Descriptors of Breathlessness in Patients With Cancer and Other Cardiorespiratory Diseases. Journal of Pain and Symptom Management, 23 (3), 182-189.