Staffing Turnover
The Corporate Strategic Plan for Dr. Soliman Fakeeh Hospital shows a focus on retaining employees under their Strategic Directive 1: Invest in People & Development (p. 14). (The Corporate Strategic Plan for Dr. Soliman Fakeeh Hospital)
Considering this primary strategic initiative, the hospital recognizes the high cost of employee turnover. Burnout can contribute to staffing turnover as can an exodus of healthcare workers to other countries for better pay and benefits.
Write a paper that addresses the financial costs associated with staffing, including costs associated with recruiting, training and turnover. You will show the calculations for retaining 2 current employees–a doctor and a nurse. You will also show the calculations for replacing these 2 employees if they quit. The relevant costs are shown below.
In your paper discuss both direct and indirect costs. Address the need to increase the number of doctors and nurses and healthcare workers in Saudi Arabia in accordance with SV2030. How can companies address that need?
Please include this information that was obtained by the finance department for the current year:
Nurses make 112 SAR per hour on average. However, the average salary for a physician is approximately 350,000 SAR per year. They normally work 8 hours per day.
Use this information to calculate retaining employees’ cost for one nurse and for one doctor for the next two years. Next, calculate the costs to replace one nurse and one doctor both of whom will have relocating expenses. Some of the costs may not be relevant in your analysis.
Hiring New Staff (Costs = SAR):
Marketing costs per employee: 19,000
Pay for relocation per employee: 19,000
Training per employee: 35,000
Nonproductive hours due to fatigue per employee during training period (current staff) per employee: 210
Retaining Employees:
Productive Time
260 days at 8 hours per salaried employee
224 days at 8 hours a day per hourly employee
Nonproductive Time
Paid Annual Leave: 21 days per employee
EID Leave: 15 days per employee
Sick Leave: 30 days per employee
Your paper should meet the following structural requirements:
The paper should be 4–6 pages in length, not including the cover sheet, reference page and the required excel sheets as an appendix to the assignment.
You must show all your calculations for credit. Your calculations for this assignment must be submitted as an Excel file, identified as Appendix A, and included as part of the Word document submission.
Formatted according to APA and Saudi Electronic University writing standards.
Provide support for your statements with in–text citations from a minimum of three scholarly articles.
One of these sources may be from the class readings, textbook, or lectures, but one must be external.
The Saudi Digital Library is a good place to find these references.
You are strongly encouraged to submit all assignments to the Turnitin Originality Check prior to submitting them to your instructor for grading. If you are unsure how to submit an assignment to the Originality Check tool, review the Turnitin Originality Check Student Guide.

To Prepare

· Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.

· Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.

· Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.

· Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis.

To Complete

Write a 2- to 3-page paper that addresses the following:

  • –  Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
  • – Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
  • – Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

· This paper should have at least 4 current references (Year 2013 and up)

· At least 2 references should be from the class Learning Resources below

The following Resources are not acceptable:

· 1. Wikipedia

· 2. Cdc.gov- nonhealthcare professionals section

· 3. Webmd.com

· 4. Mayoclinic.com

LEARNING RESOURCES

**Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

  • Chapter 35, “Structure and      Function of the Digestive System”

This chapter provides information relating to the structure and function of the digestive system. It covers the gastrointestinal tract and accessory organs of digestion.

  • Chapter 36, “Alterations of      Digestive Function”

This chapter presents information relating to disorders of the gastrointestinal tract and accessory organs of digestion. It also covers the pathogenesis, clinical manifestations, evaluation, and treatment of gastroesophageal reflux disease, gastritis, peptic ulcer disease, inflammatory bowel disease, and irritable bowel syndrome.

  • Chapter 37, “Alterations of      Digestive Function in Children”

This chapter presents information relating to disorders of the gastrointestinal tract and liver that affect children. It focuses on congenital impairment, inflammatory disorders, metabolic disorders, as well as the impairment of digestion, absorption, and nutrition.

**Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

  • Chapter 13,      “Gastrointestinal Disease”

This chapter provides a foundation for exploring gastrointestinal disorders by reviewing the structure and function of the GI tract. It also describes mechanisms of regulation of GI tract disorders such as acid-peptic disease, inflammatory bowel disease, and irritable bowel syndrome.

**de Bortoli, N., Martinucci, I., Bellini, M., Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013). Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World Journal of Gastroenterology, 19(35), 5787-5797. doi:10.3748/wjg.v19.i35.5787

**National Digestive Diseases Information Clearinghouse. (2016). Retrieved from http://digestive.niddk.nih.gov/index.aspx

Part A: Your Marketing Plan
Overview
For this assignment, you will document your hypothetical company’s background information and mission statement, your company’s short-term and long-term goals, an environmental analysis, and a SWOT analysis.
 
Note: You should make all assumptions needed for the completion of this assignment.
 
Instructions
Create the first part of your marketing plan in 8–12 pages:
 
Write an introduction to your company. Describe your hypothetical company, its location, the product it makes or the service it provides, and introduce the contents of your marketing plan.
Develop your company’s mission statement.
Decide the main goals that you would like to achieve within the next year (short term) and the main goals that you would like to achieve within the next 5 years (long term). Determine the most appropriate ways to measure both short- and long-term goals.
Note: Consider the following metrics: tracking downloads of website content; website visitors; increases in market share; customer value; new product or service adoption rates; retention; rate of growth compared to competition; and the market, margin, and customer engagement.
Develop an environmental analysis that includes competitive, economic, political, legal, technological, and sociocultural forces.
Develop both a SWOT analysis and needs analysis for your product or service. Each analysis should examine three strengths, weaknesses, opportunities, and threats for your company.
Use at least three academic resources as quantitative marketing research to determine the feasibility of your product or service. These resources should be industry specific and relate to your chosen product or service.
Use the Part A Marketing Plan Template [DOCX] to complete the assignment.
The Part A Mission Statement and SWOT Analysis Sample [PDF] containing examples has been provided for your reference.
This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.
 
The specific course learning outcomes associated with this assignment are:
 
Evaluate a company’s goals, environment, needs, strengths, and weaknesses based on its respective market.
 
 
 

Course Outcome

 HS450-2: Demonstrate how effective team building optimizes the implementation of strategic

planning.

Unit Outcomes

 Differentiate among the different types of teams and task groups and their uses in health care

organizations.

 Understand the factors associated with high-performing teams.

 Define the communication process and what constitutes effective communication.

Instructions

You are the administrator of a clinic with 50 employees. You have been tasked with facilitating

discussion with other health professionals in your clinic to select a new EHR system, which will be

implemented across the organization. Please complete the assignment as indicated in the instructions

below.

Part 1

Competency Assessed

Build effective teams.

Instructions

Construct a plan to build 1-2 effective teams to collaborate in selecting a new EHR system for the clinic.

Identify the professional roles that should be represented on your team(s). You should be prepared for

possible disagreements regarding priorities and processes, so your plan must include at least three (3)

team/consensus building methods.

Part 2

Competency Assessed

Interpret concepts of change management theories, techniques and leadership.

Instructions

Evaluate the concepts of change management theories, techniques, and leadership by assessing

typical challenges seen with implementing a new EHR system across an organization. Your evaluation

should demonstrate that you have considered how a transition to EHR would result in the need to plan

for change management interventions. Provide two (2) examples of challenges arising from EHR

adoption and detail the change management theories that you would enact to overcome resistance to

change.

Part 3

Competency Assessed

Implement a departmental strategic plan.

Instructions

Demonstrate implementation of a departmental strategic plan by detailing at least two (2) areas of risk

exposure mitigation, organizational or process re-design, training, or communication strategy, as they

relate to EHR implementation.

Part 4

Competency Assessed

Evaluate the stages of the procurement process.

Instructions

Demonstrate understanding of the purpose of the procurement process. What are the purposes of the

Request for Proposal (RFP), the Request for Information (RFI) and the Request for Quotation (RFQ)?

Provide detail for when and how to use each to help an HCO more fully identify its needs and the issues

involved with planning for significant projects or purchases.

Assignment Requirements:

● Please complete all parts in a Microsoft Word document.

● The body of your document should be at least 1200 words in length.

● Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.

● Students must cite and reference at least 4 credible sources from the KU Library.

● Please be sure visit the Kaplan Writing Center to assist you with meeting APA expectations for

written Assignments.

  • Chapter 4, Ecommerce,
  • Chapter 7, EIS, ERP,
  • IOT, Chapter 9,

Assignment

For this assignment, you will study southern california, and its unique distribution industry. In a three page paper you will address these issues:

  1. How big a role does the distribution industry (warehousing, shipping import, trucking and order management) play in the total microeconomy of southern california?
  2. What major components comprise the distribution industry?
  3. How big a role does the distribution sector play in communities such as Moreno Valley and/or San Bernardino?
  4. How large is the GDP of Riverside County versus those of LA, San Diego, and San Francisco? What role does distribution play in those numbers? What growth has taken place in Riverside County, due to the industry?
  5. What kinds of information systems are required in order to operate a distribution facility?
  6. What kinds of information systems are needed in order to manage a corporation, dedicated to the distribution sector

Full APA format and bibliography required.
(3 page)

  • attachment

    JosephValacichChristophSchneider-InformationSystemsToday_ManagingtheDigitalWorld2017Pearson-libgen.lc11.pdf

Module Overview
The real value of a dollar in your hand today is much more than what you will earn after a year. Why is it so? It is the value of time.

Imagine you won a cash prize worth $50,000 and you can choose to receive your payment either now or two years later. Which option would you choose? 

Instinctively, you would not want to wait for two years when you can get the same amount now. By receiving the $50,000 now, you will be able to increase its future value (FV) by gaining interest over a period of time if you placed it in an interest-bearing bank account. If you choose to receive the cash prize two years later, the amount will be the same—$50,000.

So how do you calculate how much more the first option is worth as compared to the second option?

In this module, you will learn about the concepts of present value (PV), FV, and compound interest and how you can use these concepts as business valuation tools to make day-to-day investment decisions.

In business, time value of money is one of the most important concepts used to make various financial decisions. This concept becomes critical for you as a manager, especially, if you contemplate raising capital, expanding operations or product offerings, selling a portion or all of the business, or merging with other organizations. Understanding time value of money will help you assign value to all aspects of your business operations, and recognize the level of risk and the expected return.

Module Readings:
Complete the following readings early in the module:

Module 3 overview
From your course textbook, Managerial economics: Economic tools for today’s decision makers, read the following chapters:
 

Capital Budgeting and Risk

Assigned Reading:

From the Argosy University online library resources, read:     

Lawler, E. E., III, & Toole, E. (Eds.). America at work: Choices and challenges. Gordonsville, VA: Palgrave Macmillan. Retrieved from http://site.ebrary.com.libproxy.edmc.edu/lib/argosy/docDetail.action?docID=10150440
McGrath, R. G., & MacMillan, I. C. (2009). How to rethink your business during uncertainty. MIT Sloan Management Review, 50(3), 25–30. (ProQuest Document ID: 224971863) http://search.proquest.com.libproxy.edmc.edu/docview/224971863?accountid=34899

 
Assignment: Required Assignment 1—Organizational Assessment

 Instructions:
 
As a manager, you have to continually evaluate the organization and its strategy and consistently adapt the business model to ensure that the overall business plan is one step ahead of the competition.

In this assignment, you will get an opportunity to learn, from actual experiences, how an informed manager would assess the current overall health of an organization and make decisions regarding future opportunities and performance.

Tasks:
 
Select an industry relevant to your career. If you lack work experience, you can base your selection on real-life market situations or business areas that you may have knowledge about. You can also consult sources such as the Wall Street Journal, Financial Times, Bloomberg Markets, the Economist, US News and World Report, and the Argosy University online library resources.

Research the growth opportunities in the industry, competitive strategies that were employed, typical customers, and other relevant information related to the industry. Specific opportunities will differ depending on the industry selected, but be sure to consider current economic events and news relating to the industry that may influence the future direction of your industry.
Within this industry, select a midrange-performing company that provides goods or services. Then, address the following:

Analyze why this company maintains the level of success it does from an economic and financial perspective. Develop at least two visual aids (e.g., charts, graphs, or tables) to support your argument.
Evaluate whether the company’s pricing and positioning decisions contribute to or hinder that success.

Evaluate whether the strategy currently used by your industry, as discussed in previous sections, appears to be sustainable over time.

Create a 4- to 5-page research paper. At the end your paper, include a reference page and cite scholarly sources in APA style.  
Turned-in on time, Grading criteria followed All assignment qualifications addressed correctly, Grading Criteria followed, Include Question followed by the answer  Reference Page Included Cover page Included, Paragraphs  Indented,  Running-head included, main heading should be centered; all  new  paragraphs should be indented;  paper should be right ragged,   not right justified; references,  should always go on a standalone  page. abstracts are not usually indented; acronyms should be spelled out when using them  for  the first time, for example HR. references as listed are APA  standard.   When you  submit your papers through turnitin.com, your overall  similarity  index  score should not be exceedingly high, with   ten to  fifteen percent  being  the maximum,  Please make sure your APA  formatting of citations. I have provided the  APA resource cite for you. https://owl.english.purdue.edu/owl/resource/560/01, Please work on using literature within the span of the last 5 years,  keep in mind there should not be any one, two, or three sentence  paragraphs 
Your response should be thorough and address all components of the discussion question in detail, include citations of all sources, where needed, according to the APA Style, and demonstrate accurate spelling, grammar, and punctuation

Submission Details:

By Monday October 29,2018, save your paper and submit your document to the Submissions Area.

This assignment is worth 200 points.
 
Assignment: Required Assignment 1—Organizational Assessment Grading Criteria & Maximum Points

The assignment showed in-depth research into the growth opportunities in the industry, competitive strategies that were employed, typical customers, and other relevant information related to the industry. 16pts.

Selected a midrange-performing company that provides goods or services within the industry. 16pts.

Analyzed why this company maintains the level of success it does from an economic and financial perspective, and developed two visual aids to support your argument. 68pts.

Evaluated whether the company’s pricing and positioning decisions contribute to or hinder that success. 60pts.

Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation. 40pts.

Portfolio Development

As you assemble your assignments into your ePortfolio, consider how the various aspects of human services professional standards lead to results in the field. With the pace of daily work and expectations in all aspects of our lives, this may not be a topic to which you normally devote a great deal of time.
For this assignment, step back and take a higher-level viewpoint. Write a synthesis of what you have learned about each of the areas in your portfolio (listed below) and include the synthesis in that category of your ePortfolio. Include in each synthesis a description of how the work in your portfolio supports what you have learned in each area. Each synthesis should require 1–2 pages to complete so that the overall length of this paper could be as brief as five pages or as long as ten pages.
Once you have created a draft, select the synthesis you wrote for one aspect and take advantage of the first discussion in this unit to obtain peer feedback. You can then use the feedback to enhance your assignment before submitting it to your instructor.
As a reminder, here are the expected categories for your ePortfolio:

  • Helping Relationships.
  • The Field of Human Services.
  • Theoretical Models.
  • The Multidisciplinary Approach to Practice.
  • Moving Forward – Professional Development Goals.

Submit a document that includes all five of your syntheses in the assignment area by the end of this unit.
Paste the link to your ePortfolio in the WRITE SUBMISSION text box in the assignment submission area for your instructor.

Requirements

  • Written communication: Written communication that is free of errors that detract from the overall message.
  • Length of paper: 5–10 typed double-spaced pages.
  • Font and font size: Arial, 10 point.

RESEARCH PAPER GRADING RUBRIC
Bio 111 Lecture Research Paper Rubric (Total 40 points)
This is the grading rubric used by the instructor for your research paper. Read this ahead of time to understand what is needed for your paper and the points that will be awarded for each area of the paper.
TO DO: 1. Learn how to use ‘end notes’ in a Word document to create your reference page (work cited). 2. Learn APA format for references.

0 – 1 point 2 points 3 points 4 points
Introduction: worth 12% (5 points)
· title page
· introduction
No title page
Introduction very weak
Title page has few mistakes
Introduction is written fair
Title page has 1 mistake
Introduction is written well
Exceptional Title page
Exceptional Introduction – captures readers attention
Instructor Comments:

Points Awarded: ___________

0 – 1 point 2 points 3 points 4 points
Body: worth 12% (5points)
· structure/organization
· flow
· Use of bullets, or automatic numbers in paper
· Use of subheadings
· No flow or no logical organization
· Too much information in one paragraph, needs to be separated into more paragraphs
· Repeated information is in paper
· No use of bullets, automatic numbers or subheadings.
· Occasional repeat of information, some not needed
· The ideas are arranged logically, although occasional ideas fail to make sense together. The reader is fairly clear about what the writer intends.
· No use of bullets, automatic numbers or subheadings.
· No repeated information unless absolutely necessary.
· The ideas are arranged logically to support the topic. The ideas usually flow easily, for the most part the reader can follow the line of reasoning.
Exceptional structure and organization. Exceptional flow of one sentence to the next, one paragraph to the next
Instructor Comments:

Points Awarded: ___________
The next 4 areas are used for content. Total content (all 4 areas added together) is worth 50% (20 points)

0 points 1 – 2 points 3 – 4 points 5 points
Describe the normal (healthy) anatomy & physiology of the major system(s) involved. Not addressed in paper · One to two areas of accuracy are questioned
· Very basic coverage of system
· Information provides reasonable support for topic
· Demonstrates an acceptable understanding of system
· Reader gains some insights
· Exceptional in accuracy supporting topic
· demonstrates a great understanding of system
· reader gains important insights
Instructor Comments:

Points Awarded: ___________

0 points 1 – 2 points 3 – 4 points 5 points
Describe the causes (etiology) and risk factors of the condition. Not addressed in paper · One to two areas of accuracy are questioned
· Very basic coverage
· Information provides reasonable support for topic
· Demonstrates an acceptable understanding
· Reader gains some insights
· Exceptional in accuracy supporting topic
· demonstrates a great understanding; very thorough coverage
· reader gains important insights
Instructor Comments:

Points Awarded: ___________

0 points 1 – 2 points 3 – 4 points 5 points
Explain how the body’s systems are affected by the condition. Brief description of signs and symptoms, clinical tests if relevant. (Note: this is not a clinical paper, do not give elaborate or lengthy details) Not addressed in paper · One to two areas of accuracy are questioned
· Very basic coverage
· Information provides reasonable support for topic
· Demonstrates an acceptable understanding
· Reader gains some insights
· Exceptional in accuracy supporting topic
· demonstrates a great understanding; very thorough coverage
· reader gains important insights
Instructor Comments:

Points Awarded: ___________

0 points 1 – 2 points 3 – 4 points 5 points
Treatments and/or cures – now and in the future (preventative measures can be addressed in this section if applicable)
Give a Very Brief description or statements only.
Not addressed in paper · One to two areas of accuracy are questioned
· Very basic coverage
· Information provides reasonable support for topic
· Demonstrates an acceptable understanding
· Reader gains some insights
· Exceptional in accuracy supporting topic
· demonstrates a great understanding; very thorough coverage
· reader gains important insights
Instructor Comments:

Points Awarded: ___________

0 -1 point 2 points 3 points 4 points
Spelling & Grammar: worth 10% ( 4 points) · Frequent spelling errors (2-3 per page)
· Frequent grammatical errors
· Spelling errors (average 1 per page)
· Grammatical errors (average 1 per page)
· Infrequent spelling errors
· Infrequent grammatical errors
Exceptional – no grammatical or spelling errors
Instructor Comments:

Points Awarded: ___________

0 -1 point 2 points 3 points 4 points
Conclusion: worth 10% (4 points) · No conclusion evident or very weak conclusion · Conclusion is weak, not covering the majority of important facts from entire paper · Conclusion summarizes most aspects of the overall paper · Conclusion not only summarizes the entries paper but has several new creative conclusions and personal insight.
Instructor Comments:

Points Awarded: ___________

0 -1 point 2 points 3 points 4 points
References: worth 10% (4 points)
· Quality of Resources
· Works cited
· Paraphrasing in text
· Quotations in text
· No works cited or incorrectly cited
· Sources used are not reliable or current
· Paraphrasing or quotations not used when necessary
· Works cited present but two areas are not correct
· 2 – 3 reliable and current sources used
· Credit given to authors about ½ of the time
· Works cited present one area not correct
· 4 – 5 reliable and current sources used (one must be conventional)
· Credit given to authors most of the time
· Works cited correctly
· 6 reliable sources used (2 are conventional and 4 are internet).
· All sources are current and cited correctly
· In text citing is excellent
Instructor Comments:

Points Awarded: ___________
Reductions: Students will lose the points listed below for not following directions:
Paper will be given zero score and rejected if paper is plagiarized, no matter if properly cited.
Late Submission of Paper – loss of 2 points per day late regardless of reasons
2 points for each page over or under the correct amount
2 points for not using proper font or spacing
2 points for not using correct margin size
Total Points:
Point Reduction: ___________
Final Score: ___________/40 points
Bio 203 Lecture Research Paper
Rubric / Aug. 2016

Respond on two different days who selected different treatments and factors than you, in the following ways:

Offer alternative common treatments for the disorders.

Share insight on how the factor you selected impacts the treatment of alterations of digestive function.

                                                        Main Post

Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.

Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome 

Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.

Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites. 

Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome

Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT).  Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.

Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome

Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner. 

Conclusion

The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.

                                                                                                                                 References

Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136

El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005

Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2

O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443

Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.

Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome 

Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.

Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites. 

Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome

Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT).  Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.

Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome

Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner. 

Conclusion

The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.

1. A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated? (Points : 0.4)       His Goodpasture syndrome should be treated with plasmapheresis and immunosuppressive therapy.       His membranous glomerulonephritis should be treated with corticosteroids.       His immunoglobulin A (IgA) nephropathy has no known effective treatments.       His Kimmelstiel-Wilson syndrome should be treated with control of high blood pressure and smoking cessation.