Assessing a patient

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Case Study

Mr. K was a 36-year- old African refugee from Somalia who immigrated to the United States from a refugee camp in Kenya. He was employed as a dishwasher with no health care benefits. Since Mr. K only had a rudimentary understanding of the English language, communication was facilitated by using a telephone translator. Mr. K was referred to a urologist at a tertiary medical center by his primary care provider (PCP) for episodic gross hematuria. Mr. K described his hematuria as intermittent, occurring 2 to 3 times per week, usually at the end of urination. He also complained of right flank pain that began several years ago after he was injured in Kenya. Prior to his visit, a renal ultrasound, urinalysis, complete blood count (CBC), and creatinine level were ordered by his PCP. His CBC and creatinine (1.0 mg/dl) were normal, and his urinalysis was negative for blood. A renal ultrasound revealed right-sided nephrolithiasis without hydronephrosis. A non-contrast computerized tomography (CT) scan of his abdomen and pelvis was normal. Upon further review, the urologist noted a thin rim of calcification in the distal right ureter and a small amount of calcification in the bladder. He believed that there could be small stone fragments in the dependent portion of the bladder. The rim of calcification in the ureter would be an unusual finding in stone disease.

At a subsequent visit one week later, Mr. K continued to complain of midline lower back pain and intermittent gross hematuria. A repeat urinalysis was negative for blood. To further investigate the hematuria, an intravenous pyelogram (IVP) was ordered to look for possible filling defects in the right ureter or presence of a stone. The IVP was normal. A flexible cystoscopy was also ordered to determine whether there were actually stones in his bladder versus artifact or other pathology.

The cystoscopy revealed a normal urethra; however, there were diffuse areas of granular golden sheen-like material beneath the bladder mucosa, which the urologist described as having a “corduroy appearance.” The “stone fragments” previously noted on the CT scan were actually this corduroy-like material below the bladder mucosa. This unusual finding prompted the urologist to schedule a transurethral bladder biopsy in the operating room under anesthesia. The urologist reviewed the pathology results of the bladder biopsy and consulted with various experts in pathology. Because the patient had recently emigrated from Somalia, there was suspicion of a parasitic component.

Epidemiologists Unite!
The local epidemiologists are called to the facility. ANSWER THE QUESTIONS BELOW:

Q1.What questions do you have for the patient? The health care providers? Is there anyone else to interview and if so what questions are asked?

Q2.What infectious diseases are endemic to Somalia? Kenya?

Q3.Who else may be in danger and what actions must you take in order to prevent more cases from occurring and identify potential cases as quickly as possible?

Q4.What infectious diseases (and their agents!) would be part of your differential diagnosis?

Q5.What is the agent? How do you come to this determination? Explain how the symptoms and other clues helped you determine possible agents.

Q6.What public health actions need to occur now? Are there policies that can be put in place? Why or why not?

Q7. Who would you work with to design policies and why? What are the ethical principles guiding your policymaking approach?

 

 

 

Sample Solution

 

 

 

Why We Believe Horoscopes

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horoscope essayLiving in the 21st century implies living in the period of innovative miracles, permitting individuals to do things that would be viewed as enchantment a century back. TV, the Internet, mobile phones, space flights, shot trains, computer generated reality, and holographic and three-dimensional pictures are only a few models exhibiting the unimaginable mechanical advancement humankind has made during late decades. At the same time, numerous individuals despite everything have faith in ungainly and in some cases silly marvels, similar to superstitions, enchantment, crystal gazing, etc. Particularly this proposal alludes to crystal gazing; albeit numerous individuals guarantee horoscopes for their zodiac signs are “totally obvious,” science demonstrates it is just a matter of discernment.

In the event that you have ever perused a horoscope for the zodiac sign you were brought into the world under, you more likely than not saw that occasionally “expectations” about your character qualities, way of life, connections, or vocation can by one way or another appear to be precise. Luckily, this doesn’t imply that far off stars and planets some way or another influence your fate; considerably more likely, in such cases, you are encountering what is known as the Barnum Effect.

For the most part, the Barnum Effect (additionally called the Forer Effect) implies individuals’ inclination to take obscure and summed up qualities of themselves as precise and honest (Paranormality). Or then again, at the end of the day, it implies that individuals acknowledge qualities that can apply to numerous individuals as close to home and precise just for themselves.

Here is a mental trademark made out of the announcements utilized by the American clinician Bertram Forer in the analysis that demonstrated the impact. He furnished every one of his understudies with the accompanying content, and every one of the understudies remembered it to be their exact mental trademark:

You have an incredible requirement for others to like and respect you. You tend to be disparaging of yourself. You have a lot of unused limit which you have not made advantageous for you. While you have some character shortcomings, you are commonly ready to make up for them. Your sexual change has displayed issues for you. Restrained and self-controlled outside, you will in general be troubling and uncertain inside. On occasion you have genuine questions regarding whether you have settled on the correct choice or made the best choice. You lean toward a specific measure of progress and assortment and become disappointed when stitched in by limitations and constraints. You pride yourself as a free scholar and don’t acknowledge others’ announcements without palatable evidence. You have thought that it was impulsive to be excessively forthcoming in uncovering yourself to other people. On occasion you are outgoing, approachable, friendly, while at different occasions you are withdrawn, watchful, held. A portion of your desires will in general be truly unreasonable. Security is one of your significant objectives throughout everyday life. (Forer)

As should be obvious, the announcements above can be pretty much applied to nearly anyone. No compelling reason to state that horoscopes for the most part comprise of expressions that to a critical degree look like (or even rehash) those in the displayed content. Now and then, horoscopes can be totally precise. For instance, a Gemini author may peruse that their sign is inclined to composing and additionally scholarly work. In any case, such cases are either incidents (only one out of every odd Gemini, all things considered, is an essayist, or if nothing else gifted recorded as a hard copy), or represent an individual’s capacity to discover particularities in dubiousness.

Crystal gazing and horoscopes ought not be trusted. Albeit a portion of the forecasts may appear to be staggeringly precise, this is a deception brought about by the quirks of how our brains work. Individuals will in general acknowledge summed up qualities as exact and relevant to themselves; this is known as the Barnum (Forer) Effect, and it is liable for making use consider horoscopes to be something sound.

References

“Barnum Effect.” Paranormality. N.p., n.d. Web. 06 Nov. 2014.

Forer, B.R. (1949). “The Fallacy of Personal Validation: A Classroom Demonstration of Gullibility.” Journal of Abnormal and Social Psychology (American Psychological Association).

 

 

 

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