Final Mini Literature Review
Revise and finalize your Mini Literature Review. Keep in mind that you can use the Walden Writing Center services (such as Grammarly) to help you with editing your Final Mini Literature Review.
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Nature and scope of Crohn’s Disease
Crohn’s disease is a debilitating chronic inflammatory bowel disease that predominantly affects the terminal ileum and colon and is associated with unique pathological features (Ha & Khalil, 2015). The pathological features are characterized by focal, asymmetric, occasional, transmural, and granulomatous inflammation that mainly affect the gastrointestinal tract. The incident of Crohn disease varies on the regions and demographics. In the western countries, 50 to 200 per 100,000 people are diagnosed with Crohn disease (García-Sanjuán et al., 2014).In the United Kingdom, North America and the Northern part of Europe, the prevalence is high. A recent study in Finland showed an increasing incidence in the region. Traditionally, incidences of disease in Asia and Africa have always been low but are still increasing (Urlep et al., 2015).Although the disease can occur at any age, common incidences are often seen in the early thirties and late fifties.
Crohn’s disease can cause morbidity mostly with initial symptoms including diarrhea, rectal bleeding, abdominal pain, fecal incontinence, and fatigue. The disease is neither medical nor surgically curable, thus requires management or therapeutic approach that induces and symptomatic control, minimize toxicity or complication and improve the quality of care of the patient (Winter & Burakoff, 2016). Overall, the healthcare delivery for a patient with Crohn’s disease is not optimal in the United States and other parts of the world and need improvement. Evidence suggests a variation of care provided but inflammatory bowel diseases experts when it comes to Crohn’s disease particularly because the delivery of care is often complex and need coordination between experts. On this note, the aim of this paper is to explore Crohn’s disease by examining how the delivery of care can be improved.
The underlying cause of the intestinal inflammation that characterizes Crohn disease has continuously remained heavily contested. Earlier theories concentrate on ineffective etiologies, but over the years, some studies have shifted their focus to immunological response, claiming that its disruption gut microbiota in susceptible individuals (Baran, & Karaca, 2013). Lie and Anderson (2014), notes that the first Crone disease test was conducted in Japan on its population and was aimed to determine the susceptibility locus. Similar studies have been conducted each including cases of more than 500-2000 of Crohn diseases (Lie and Anderson, 2014). Most of the study designs, method, and strategies used to health research regarding Crohn disease such as the one mentioned above primarily focused on risk factors in a given population. Only a few research studies or designs have considered the health care delivery of Crohn disease.
As noted, there is of definitive care for people with Crohn disease, thus, according to García-Sanjuán et al. (2014),the main objective in healthcare and healthcare research should mostly include induction of remission, and minimizing complication of disease and improvement of the quality of care. Additionally, the focus should be to reduce the number of surgeries and hospitalization and maintenance of pediatric patient linear growth. The study by Lo and colleagues (2017) shows changes in diseases is population-based and behaviors in patients with Crohn disease often increaseresection risks. The authors assert the importance of biological treatment and maintenance in regards to disease change in location, which may improve the disease sequence of the patient. In essence, this also means that culture and behavioral factors could also inhibit improvement of quality care of the Crohn disease.
Although the advancement of inflammatory bowel disease includes therapies, a large need is unmet through these therapies for the patient with chronic disease. According to Sales-Campos et al. (2015), drug development through clinical trials have brought notable hopes and have also become important in understanding the efficacy of new therapies through technology. On the same note, Makharia, (2014) notes that health care technological measures such as the use of automated entry of therapeutic orders, electronic medical record system and other technological measures has increased the quality of care of patients with Crohn disease. In essence, this shows the importance of technologies in addressing the unmet needs from current therapeutic measures.
Nonetheless, the need for ethical trial design is imperative. Precisely, the design must adhere to uniformly accept the standard of human subject research. When considering the principle justice in bioethics Rubin, Becker, and Siegler (2014), reports assert that since some population may be more susceptible to harm than other especially when it comes to clinical trials, it is important the effect to the population. Another area of vulnerability is the patient with refractory inflammatory bowel diseases, among them the Crohn’s disease (Rubin, Becker, and Siegler, 2014). Such patient may be vulnerable because of their health care experiences with the poor healthcare deliveries and management, which may increase the propensity to make a health care decision that, will affect them accordingly.
Pain is a complex condition; it changes the function of the patient brain and body affecting emotions, relationships, and one’s career. Thus, it follows that an effective treatment plan must consider all aspect of pain. On this note, it is important for any treatment method to incorporate inter-disciplinary approaches such as therapies, behavioral and other plans to reduce pain, and ultimately improving the quality of life of the patient. Crohn disease and related structure show a poor response to medical therapy, therefore for management of condition to be effective incorporating other approaches such as surgical bowel resection is needed. The approach can help improve patient outcome and increase the level of satisfaction, reduce the length of stay, avoid duplication and leader to a holistic record of care. The downside of such approach is that personalized care may not be possible which is fundamentally important to patients with Crohn disease.
Crohn’s disease severity and possible extraintestinal manifestation mean that the patient may have to be hospitalized for a long time or may undergo surgery (Feuerstein & Cheifetz, 2017). As with any other chronic condition, the healthcare delivery from the health care professional must plat a significant role in the improvement of the quality of life. The evaluation of the quality of care considers the services provided, but more importantly the perception of a practitioner toward the disease. Evidence suggests that Crohn’s disease management is particularly difficult because the delivery of care is often complex and need coordination between experts (Feuerstein & Cheifetz, 2017). The perception of the practitioner toward the disease may inhibit the quality of care. The painful inexperience caused by ineffective care from the past may affect the patient perception of the disease, which ultimately affects the quality of care. The healthcare organization performance also plays a critical role in the delivery of care. The macro and micro factors include cost factors, technologies competitive factors, and government policies.
Health care management theory such as evidence-based management theory suggests that health care professional must be making a decision based on available evidence to improve the care of the patient. A practical consideration often makes the transition from evidence-based theory making it hard to practice, but imposing the standards of the decision-making process is a level of uniformity to the decision of the practitioner. Other theories such as utilization management theory can be used to improve the quality of care for Crohn disease patients.
To assess the quality of care of the patient, Vasudevan et al., (2013) proposes the use of chronic disease models such as the QUOTE survey in clinic patients, which can help determine the potential deficiencies in care quality, from the perspective of the patient and thus amenable to change. Different organizations have developed quality measures, which has been used in federal health insurance programs and provides financial incentives rather than quality improvement purposes. Norton et al. (2013) report that, lack of knowledge on the part of health employee is a substantial barrier to patients with Crohn’s disease. Therefore, to ensure quality improvement in health care, the human resource must efficiently recruit healthy employees who have a positive attitude towards Crohn disease.
In conclusion, focusing on health care delivery is essentially important for patients with Crohn disease. In particular, because the condition is neither medical nor surgically curable, thus requires management or therapeutic approach that induces and symptomatic control, minimize toxicity or complication and improve the quality of care of the patient. Evidence suggests that health care delivery for patients with Crohn’s disease is not Optimal in the United States and other parts of the world and need improvement. To do that, the focus should be on particular demographic, and a population that is most susceptible to changes in diseases is population-based, and behavior in patients with Crohn disease often increase the risk of resection. This should include utilization of health care technologies, and research while considering ethical and legal issues. In addition to this, an interdisciplinary approach should be used to increase the quality of care.
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García-Sanjuán, S., Lillo-Crespo, M., Sanjuán-Quiles, Á, Gil-González, D., & Richart-Martínez, M. (2014). Life Experiences of People Affected by Crohn’s Disease and Their Support Networks. Clinical Nursing Research, 25(1), 79-99. doi:10.1177/1054773814543828
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