...of the fundamental guidelines of clinical ethics. Autonomy in medicine is not simply allowing patients to make their own decisions. Physicians have an obligation to create the conditions necessary for autonomous choice in others. For a physician, respect for autonomy includes respecting an individual’s right to self-determination as well as creating the conditions necessary for autonomous choice. Individuals come to doctors for guidance in making choices because they do not have the necessary background or information for making informed choices. Physicians educate patients so that they understand the situation adequately. They calm emotions and address fears that interfere with a patient’s ability to make decisions. They counsel patients when their choices seem to be disruptive to health and well-being. Respect for autonomy also includes confidentiality, seeking consent for medical treatment and procedures, disclosing information about their medical condition to patients, and maintaining privacy. Some of the most common and difficult ethical issues to navigate arise when the patient’s autonomous decision conflicts with the physician’s beneficent duty to look out for the patient’s best interests. For example, a patient who has had bypass surgery may want to continue to smoke or a patient with pneumonia may refuse antibiotics. In these situations the autonomous choice of the patient conflicts with the physician’s duty of beneficence and following each ethical principle...
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...ADHD: Multimodal Approach Lynnette Walker University of North Florida Abstract This paper reviews Attention Deficit/Hyperactivity Disorder (ADHD), the many effects the disorder has on an individual, and the many therapy options available. A brief description of the disorder is given, as well as the core symptoms, and the functional problems that result from it. Each therapy option is then explained in detail and the benefits of each given. Finally, a brief look at the advantages of using multiple therapy techniques in a multimodal approach and the needs for future research. ADHD: Multimodal Approach ADHD (Attention Deficit/Hyperactivity Disorder) is a common disorder that typically presents in early childhood and often continues into adulthood. It is a chronic disorder that has no cure. There are two components of ADHD, attention deficit and hyperactivity. The attention deficit component refers to the lack of attention or difficulty in focusing on activities for extended periods of time, as well as being easily distracted. The hyperactivity component refers to impulsivity, restlessness, fidgeting, and often loud behavior. In order to be diagnosed with ADHD, a patient must exhibit a number of these behaviors that are atypical to children of the same age for at least six months, symptoms having been present before the age of 7, be present in more than one environment, and show impairment in social and academic progress (Monastra, 2008). There are many functional deficiencies...
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...Chapter 33. Professional Communication and Team Collaboration Michelle O’Daniel, Alan H. Rosenstein Background In today’s health care system, delivery processes involve numerous interfaces and patient handoffs among multiple health care practitioners with varying levels of educational and occupational training. During the course of a 4-day hospital stay, a patient may interact with 50 different employees, including physicians, nurses, technicians, and others. Effective clinical practice thus involves many instances where critical information must be accurately communicated. Team collaboration is essential. When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, and overlooked changes in status.1 Lack of communication creates situations where medical errors can occur. These errors have the potential to cause severe injury or unexpected patient death. Medical errors, especially those caused by a failure to communicate, are a pervasive problem in today’s health care organizations. According to the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCHAO), if medical errors appeared on the National Center for Health Statistic’s list of the top 10 causes of death in the United States, they would rank number 5—ahead of accidents, diabetes, and Alzheimer’s disease, as well as AIDS, breast...
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...different risk factors, such as life changing events or traumatic experiences, can lead to episodic depression, which is normal in most cases. Others may experience chronic severe depression with extreme, debilitating symptoms, which are at higher risk of suicide. During the early development of psychology, depression was not initially viewed as a psychological disorder. Due to the evolution of psychology as a science, psychologists have a more profound understanding of how one’s biological and environmental factors affect one’s moods, behaviors, and overall health. Today, depression is a commonly diagnosed and treated psychological disorder. Professionals have developed various psychological tests and measurements to effectively diagnose and treat depression. One commonly used tool to measure depression is the Hamilton Depression Rating Scale or HDRS. Summarize selected articles The Hamilton Depression Rating Scale was created to help determine patient levels of depression. The information collected was used during, before or after a patient’s treatment. According to (Bagby &.Ryder, 2004) “The author’s tries to determine whether continued use of the Hamilton Rating Scale is justifiable.” Since the scale was originally developed in the 1950’s to assess it’s effectiveness on antidepressents, it became a common tool...
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...person can be diagnosed with ADHD. Males are twice more possible to get identified with ADHD than females. Grownups may acquire signs and then be evaluated to get diagnosed. ADHD was formerly named hyperkinetic impulse disorder. It didn't exist until the late 1960s that the American Psychiatric Association (APA) officially acknowledged ADHD as a mental illness. The perception of hyperactivity as an illness triggered by roughly more than neurological impairment was brought back up in 1960. In 1960, it was explained that the "Hyperactive Child Syndrome" is an environmentally-based difficulty initiated by inadequate parenting. Concepts indicated that there should be a re-evaluation of the background on ADHD all through each of its topics. As an outcome of re-evaluation, the approved therapeutic name of the illness remained altered to Minimal Brain Dysfunction (MBD). Additionally, in 1965, the American Psychiatric Association replaced the name once more to "Hyperkinetic Reaction of Childhood," following the assumption that hyperactivity was not a common illness, however, a real problem. Corresponding to this concept, parents (mainly mothers) remained the guilty party for the cause of the disease. Consequently, expert hypotheses had cycled back around to the times before 1902's way of...
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...Substitution treatment or maintenance pharmacotherapy programs using methadone are today the most sought after and effective form of treatment for opiate addiction and dependence. Because methadone is a long-acting opiate whose dosage can be stabilized, it is well suited for daily administration and has proven effective in the elimination of narcotic craving, a driving force behind continued heroin use. And, because it can be administered orally, methadone dramatically reduces heroin injecting frequency and, with it, associated risks for HIV and other blood-borne pathogens. Methadone Treatment Effectiveness The clinical effectiveness of methadone is most commonly measured by its retention of patients in care and by reductions in heroin use as well as improvements in social outcomes, for example, employment, family integration, and reduced arrests and incarceration for criminal...
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...medication is not the only treatment for ADHD, it seems to be the most popular resource. Some families have found behavioral therapy and a change in diet are also successful methods to treat the symptoms of ADHD. Many other issues can manifest itself as ADHD like allergies or long term exposure to lead paint; which makes diagnosing ADHD a controversial issue because like other psychological disorders. There is no physical or diagnosis test available and it is simply diagnosed based on a list of observed behaviors and is usually teacher referred for more evaluation. "A child is liable to be diagnosed ADHD if he or she steps out of line, speaks out of turn. In short, just about any sort of disorderly conduct would beget on the part of a teacher a suspicion of ADHD or might even lead to that teacher making such a diagnosis"(Films On Demand, 2009). The diagnosis of ADHD did not come about until the late 80's and prior to that, hyper activity was described among other behaviors as a mental disorder (Films On Demand, 2009). Fuermaier & Hauser (2015) state ADHD in childhood is associated with academic failure, social...
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...nursing. 7. Describe organizational Structures that Support Moral Courage 8. Case studies "Stand up for what is right even if you stand alone." Anonymous Examples of unethical behaviors are seen today in academia, politics, sports, entertainment, banking, and the legal system. Healthcare professionals working in clinical practice, education, research, and administration are not immune to these unethical behaviors. They face ethical dilemmas on a regular basis. Shortages in the numbers of clinicians to deliver patient care, inadequate staffing levels, cost containment measures, consolidation of healthcare organizations and ineffective leadership have resulted in the escalation of ethical dilemmas nurses face today in healthcare environments. How individuals respond to these ethical dilemmas depends on their previous experiences with unethical behavior, their individual personality traits, their ethical values as well as their knowledge of ethical principles. Moral courage is needed to confront unethical behaviors. The following exemplar demonstrates moral courage in clinical practice. Emily was a novice nurse employed at an academic medical center. Her peers respected her and described her as an attentive and meticulous nurse with strong work values. Over time Emily noted a behavior in the work setting that concerned her and...
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...HIV/AIDS Bureau, Health Resources Services Administration, United States Department of Health and Human Services, to the National Health Care for the Homeless Council, Inc., and its subsidiary, the Health Care for the Homeless Clinicians’ Network. The views presented in this paper are those of the author and do not necessarily represent those of the United States government or of the National Health Care for the Homeless Council. Nothing in this paper should be construed as providing authoritative guidelines for the practice of medicine or for treatment of medical conditions. This paper may be reproduced in whole or in part with appropriate recognition to the author, John Y. Song, MD, and the publisher, the Health Care for the Homeless Clinicians’ Network, National Health Care for the Homeless Council, Inc. Second Printing February, 2000 National Health Care for the Homeless Council Health Care for the Homeless Clinicians’ Network Post Office Box 60427 Nashville TN 37206-0427 Phone 615/226-2292 Fax 615/226-1656 council@nhchc.org or network@nhchc.org http://www.nhchc.org i PREFACE HIV/AIDS and homelessness are twin plagues that take a staggering toll. Each condition complicates the other, and lives hang in the balance as health care providers and their patients try to sort through the complications and assure critical services. This paper is dedicated to the improvement of HIV/AIDS care for homeless people, and to the end of both of these plagues. In considering HIV/AIDS and...
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...Can essential fatty acid supplementation play a role in the treatment of Attention-Deficit Hyperactivity Disorder? For submission 22nd April 2006 Dissertation, 3rd Year ION Contents Abstract 3 1.0 Introduction 4 1.1 Prevalence 4 1.2 Diagnosis 4 DSM-IV Checklist for Diagnosing ADHD 6 Figure 1. DSM-IV Checklist for Diagnosing ADHD 6 1.3 Associated Conditions 7 1.4 Prognosis 7 1.5 Aetiology 7 1.5.1 Genetics 8 1.5.2 Environmental Influences 8 1.5.3 Essential Fatty Acids 8 1.5.4 Food Sensitivities 9 1.5.5 Heavy Metal Toxicity 9 1.5.6 Nutrient deficiencies 9 1.5.7 Pregnancy/birth trauma 10 1.5.8 Hypoglycaemia 10 1.5.9 Digestive 10 1.5.10 Thyroid 11 1.6 Clinical Management 11 1.7 Understanding the Role of Essential Fatty Acids 12 1.7.1 What are Essential Fatty Acids? 12 Figure 2. Major Food Sources of Essential Fatty Acids 12 Figure 3. Omega-3 and Omega-6 metabolic pathways 13 1.7.2 Essential Fatty Acids and Brain Function 13 1.7.3 Physical Signs of Fatty Acid Deficiency 14 2.0 Literature Review 15 2.1 DHA Supplementation 15 2.2 Combined DHA, EPA, GLA Supplementation 18 2.3 Combined EPA, DHA, ALA Supplementation 19 2.4 ALA Supplementation 22 2.5 Summary of studies reviewed 23 Figure 4. Summary of Studies Reviewed 23 3.0 Discussion 24 3.1 Future Research 27 4.0 Conclusion 28 5.0 Nutritional Strategy 29 5.1 Benchmarking 29 5.2 Dietary Strategy 29 5.3 Lifestyle Strategy 29 5.4 General Supplement programme...
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...of university staff in providing assistance to students with BPD. The chapter concludes with a summation of considerations in assisting university students with severe symptoms of BPD while on campus. 1.2 Borderline Personality Disorder 1.2.1 The development of the Borderline construct Reliable and valid differentiation of the borderline construct has proved elusive. The phenomena was initially reported in psychodynamic literature in the 1930’s, however was not distinguished as a syndrome until 1953 (Knight, 1953). Indeed, the use of the term ‘borderline’ arguably represents a misnomer due to its association with early difficulty in characterising an indistinct set of symptoms (Zhong& Leung, 2007). Observations of the era indicate patients displayed both classic symptoms of neurosis and concurrent indicators of psychosis, in the absence of polarization toward either (Knight, 1953). Subsequently, the presentation was regarded to represent a diagnostic mid-point or...
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...on campus are discussed in terms of the role of university staff in providing assistance to students with BPD. The chapter concludes with a summation of considerations in assisting university students with severe symptoms of BPD while on campus The development of the Borderline construct Reliable and valid differentiation of the borderline construct has proved elusive. The phenomena was initially reported in psychodynamic literature in the 1930’s, however was not distinguished as a syndrome until 1953 (Knight, 1953). Indeed, the use of the term ‘borderline’ arguably represents a misnomer due to its association with early difficulty in characterising an indistinct set of symptoms (Zhong& Leung, 2007). Observations of the era indicate patients displayed both classic symptoms of neurosis and concurrent indicators of psychosis, in the absence of polarization toward either (Knight, 1953). Subsequently, the presentation was regarded to represent a diagnostic mid-point or borderline between...
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...Abstract It is very obvious that the government has stepped up to the plate to start what could be a very successful venture. But, at this point continued intervention is needed. It is recognized that there are still technical issues related to functionality and interoperability. The problems appear to be due to sociological, cultural, and financial problems. But, in the end most would agree that the issues are related to managerial more than technological problems. Experience and research implemented by those with failures have identified the most important concerns being,” what constitutes success and what is failure?” Their question is what contributes to making successful or unsuccessful systems? How do these companies use their system failures to enhance learning opportunities for continued company improvement? How should they study this success or failure? The determination was related at workshops directed by the AMIA to enhance opportunities for future successes, with a research agenda and recommendations. The AMIA was convicted to take a leadership role and come up with practical projects that would likely succeed in a health care setting. Introduction In February 2009 Congress appropriated $20 billion for health information technology as a part of the President’s stimulus package. Then the United State joined with other countries to benefit from healthcare technology. Because of the changes made to Medicare and private insurance...
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...Nursing Theory Plan of Care Nursing Theory Plan of Care Transforming nursing research evidence into practice and policy is essential for the provision of quality care. Research utilization is defined as “the systematic process of transferring research knowledge into practice for the purpose of understanding, validating, enhancing, or changing practice” and has a potential to influence attitudes, beliefs, and behaviors of healthcare providers and recipients, alike (Matthew-Maich, Ploeg, Jack, & Dobbins, 2010). Most practical nursing disciplines create mechanisms of research utilization that, according to MacGuire (2006), can “clearly explicate the essential nature, meanings and components of nursing so that nurse clinicians can use this knowledge in a deliberate and meaningful way.” There are some difficulties with the process of transforming research findings into practice. Nurses may not know about the research finding, or they may find the changes to be disruptive and resist implementing them. They may not have the appropriate training or funding, or simply may not have the autonomy to apply the knowledge into their practice independently (MacGuire, 2006). When successfully implemented, research findings encourage nurses to make thoughtful and informed choices, to avoid automatic reactions based on old assumptions and practices, and to afford them ability to understand and critique research evidence in relation to their practice. Sometimes, a new idea could be rightfully...
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...ARTICLE IN PRESS Sleep Medicine Reviews (2008) 12, 153–162 www.elsevier.com/locate/smrv CLINICAL REVIEW Caffeine: Sleep and daytime sleepiness Timothy Roehrsa,b,Ã, Thomas Rotha,b a Sleep Disorders and Research Center, Henry Ford Hospital, 2799 W Grand Blvd, CFP-3, Detroit, MI 48202, USA b Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State University, Detroit, MI, USA KEYWORDS Caffeine; Daytime sleepiness; Sleep disturbance; Caffeine dependence Summary Caffeine is one of the most widely consumed psychoactive substances and it has profound effects on sleep and wake function. Laboratory studies have documented its sleep-disruptive effects. It clearly enhances alertness and performance in studies with explicit sleep deprivation, restriction, or circadian sleep schedule reversals. But, under conditions of habitual sleep the evidence indicates that caffeine, rather then enhancing performance, is merely restoring performance degraded by sleepiness. The sleepiness and degraded function may be due to basal sleep insufficiency, circadian sleep schedule reversals, rebound sleepiness, and/or a withdrawal syndrome after the acute, over-night, caffeine discontinuation typical of most studies. Studies have shown that caffeine dependence develops at relatively low daily doses and after short periods of regular daily use. Large sample and population-based studies indicate that regular daily dietary caffeine intake is associated with disturbed...
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