...Case Study Two: HTN, CKD, & Hypothyroidism Managing Co-Morbidities in Primary Care Primary care providers treat many patients with co-morbidities. It is important for primary care providers to utilize the most current evidence-based research and guidelines to treat and manage patients with co-morbidities in order to reduce risk factors and improve overall health. The following case study will be utilized to apply current guidelines for the treatment and management of hypertension (HTN), chronic kidney disease (CKD) and hypothyroidism including patient education, monitoring, and clinical end points. Case Study A 45 year old African American male returns for a six month follow-up for blood pressure (BP) control. The patient complains of on-going symptoms over the past few months of dry cough, sleep disturbances, fatigue, constipation, weight gain, and dry skin. The patient denies pain, shortness of breath, edema, or sputum production. Pulse is 80 and regular, BP is 148/110, and BMI is 28. He is six feet tall and weighs 205 pounds. Labs reveal TSH of 5.2, free T4 of 0.8, free T3 1.8, Creatinine 2.1, BUN 22. Family history includes stroke, heart attack, and high cholesterol. Current medications are daily multivitamin, Lisinopril 10 mg once daily, over-the-counter (OTC) Robitussin, and OTC laxative as needed (University of Phoenix, 2014, Week Seven Case Study). The patient can be diagnosed with uncontrolled HTN, subclinical hypothyroidism, and may have chronic kidney...
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...| Incidence density | | D. | None of the above. | | E. | | 5 points Question 2 1. Dr. Breathright conducted a study to estimate the incidence of asthma among inner city children. She recorded the amount of follow-up person-time in the table below. The number of children diagnosed as a new case of asthma during the 12 month follow-up period was 15 cases. Which of the following equations could be used to correctly calculate incidence density for asthma in this study? Complete the table to help you determine the answer. Participant follow-up: | No. of participants | Number of Months of Observation per participant | Total Person-Months | | 100 | 12 | | | 90 | 11 | | | 65 | 8 | | | 50 | 7 | | | 10 | 5 | | Totals | 315 | 43 | | Answer | A. | 15 cases / 3110 person-months at-risk | | B. | 15 cases / 315 children at-risk | | C. | 315 cases / 3,110 person-months at-risk | | D. | None of the above | 5 points Question 3 1. In Newcity, TX, there were 70,000 women over age 25 years at the beginning of 2007. Of these women, 3,000 had breast cancer at the beginning of 2007. At the beginning of 2008, 25,000 of the women in the population are currently cancer free and are at-risk for postmenopausal breast cancer. These women participated in a cohort study and contributed 40,000 person-years of follow-up time at risk from 2008-2010. Collectively, they experienced 112 new cases of postmenopausal breast cancer...
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...176:266-272. Access the most recent version at DOI: 10.1192/bjp.176.3.266 Suicide in psychiatric hospital in-patients : Risk factors and their predictive power References This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/176/3/266#BIBL To obtain reprints or permission to reproduce material from this paper, please write to permissions@rcpsych.ac.uk http://bjp.rcpsych.org/cgi/eletter-submit/176/3/266 http://bjp.rcpsych.org/ on April 6, 2012 Published by The Royal College of Psychiatrists Reprints/ permissions You can respond to this article at Downloaded from To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/ B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 0 ) , 1 7 6 , 2 6 6 ^ 2 7 2 Suicide in psychiatric hospital in-patients Risk factors and their predictive power JOHN POWELL, JOHN GEDDES, JONATHAN DEEKS, MICHAEL GOLDACRE and KEITH HAW TON Background Psychiatric hospitalinpatients are knownto be at high riskof highriskof suicide, yetthereislittlereliableknowledge of risk factors or their predictive power. Aims To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide. Method Using a case ^ control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with112 randomly selected controls.Univariate analysis and multivariate...
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...Medical Education and Research (JIPMER), Pondicherry - 605006, India RESEARCH Please cite this paper as: Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Outcome of ventilatorassociated pneumonia: impact of appropriate therapy and other factors. AMJ 2012, 5, 2, 135-140. http//dx.doi.org/10.4066/AMJ.2012.1004. Corresponding Author: Dr. Noyal Mariya Joseph, Assistant Professor, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry – 607 402 (India) Email: noyaljoseph@yahoo.com Please use these fonts and font sizes only. Abstract inappropriate therapy (defined as lack of coverage of one or all the significant VAP pathogens) were at significantly high risk for death (Relative risk, 2.00; 95% confidence interval, 1.14 to 3.52; P 0.0008). A delay of > 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not have significant impact on the outcome of VAP. Conclusion Early administration of appropriate antibiotic therapy, based on the antibiogram of the VAP pathogens identified by quantitative culture of endotracheal aspirate, could lead to an improved outcome of patients with ventilatorassociated pneumonia. Key Words Ventilator-associated pneumonia; appropriate therapy; quantitative culture;...
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...application of palliative options MARIJKE C. JANSEN-VAN DER WEIDE, M.SC., BREGJE D. ONWUTEAKA-PHILIPSEN, PH.D., AND GERRIT VAN DER WAL, PH.D., M.D. Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands ~RECEIVED June 5, 2006; ACCEPTED August 27, 2006! ABSTRACT Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide ~EAS!, the extent to which the options were applied, and changes in the patient’s wishes. Methods: In an observational study, 3614 general practitioners ~GPs! filled in a questionnaire and described their most recent request for EAS ~if any! ~n 1,681!. Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option ~67%!, and applied most frequently ~79%!, together with radiotherapy, most frequently resulted in patients withdrawing their request. Significance of results: GPs include the availability of palliative options in their decision making when considering EAS. The fact that not all options are applied or, if applied, the patient persists in the request is related to autonomy of the patient, the burden on the patient, and medical futility of the option. KEYWORDS: Euthanasia, Physician-assisted...
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...experiences of others within the realm of infertility treatments. I attended a conference last month in which the specialist recommended seeing an acupuncturist as an adjunct method for increasing fertility. This therapy would be a meeting of old world Eastern therapy and the new advancements of Western medicine. This idea has left me wondering if there is greater success when using acupuncture in conjunction with IVF compared to using IVF alone. Johnson, D. (2006). Acupuncture prior to an at embryo transfer in an assisted conception unit – a case series. Acupuncture in Medicine, 24(1), 23-28. This article gives data from a quantitative research study that compared IVF success rates with patients undergoing acupuncture therapy prior to and after embryo transfer with patients who participated in IVF only. The sample population for this case study involved 22 female patients voluntarily electing IVF treatment at an England hospital between 2002 and 2005, with average age of 36.2 years. All patients were self-referred for acupuncture by seeing pamphlets placed in the lobby of the IVF treatment facility. The acupuncture treatment included one treatment at the beginning of the IVF cycle, two days prior to egg collection, and a final session on the day of embryo transfer. The comparison group would be comprised of 265 females with average age 36.3 years undergoing IVF treatment alone. There was a 57.7% pregnancy success rate in women receiving...
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...Introduction: Affecting 64% of all dementia cases (Alzheimer’s Society of Canada, 2014), Alzheimer’s disease is a growing problem today. With close to 90 000 cases of dementia reported in the greater Toronto area (GTA) (Hopkins, 2010) and the number continuing to rise, it is a widespread problem in society. Alzheimer’s disease is characterized by memory loss, difficulty completing daily tasks, confusion, communication problems, and emotional and social changes (Alzheimer’s Association, 2014). Alzheimer’s disease is most common from age 65 onward. There is no cure to alzheimer’s disease, and the exact mechanisms are unclear. Current research suggests that plaques and tangles are responsible for the destruction of neurones, leading to symptoms...
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...occurrence of dental extractions and tooth loss has certainly risen exponentially. Unfortunately, tooth loss, whether it is through dental extractions or other means, has long term clinical sequelae associated with it. Osteonecrosis of the jaw, bacteremia, orbital cellulitis, and other psychological and physiological clinical sequelae that impact the well-being of the patient will be discussed. Osteonecrosis of the jaw (ONJ) is defined as the presence of exposed bone in the mouth that fails to heal after appropriate intervention over a period of 6 to 8 weeks (Reid), and results in chronic osteomyelitis with areas of bone necrosis. Most commonly affecting the mandible (Bagan), patients with ONJ experience symptoms that range from painless exposed bone to severe jaw pain (Sambrook). The majority of cases of ONJ have been found to be initiated and associated with tooth extraction procedures as a result of the introduction of oral flora to the exposed jaw bone that prevents healing and becomes infected (Ruggiero). In addition to tooth extractions being a precipitating event to ONJ, it has been found that ONJ occurs in patients who have previously undergone chemotherapy treatment for cancer and take bisphosphonate medications to counteract the effects of osteoporosis. Bisphosphonates are used for cancer treatment and osteoporosis because of its anti-angiogenic properties and ability to inhibit osteoclast action, respectively. This in turn manages the hypercalcemia that is seen in bone...
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...Patient Safety/Quality Care/Improvement Case Study The Patient Safety defines health errors as “the disappointment of a designed action to be finished as planned or the use of an incorrect plan to attain an aim(Longo, D., Hewitt, J. E., Ge, B., & Schubert, S., 2007).” Health errors do not all effect in damage or grievance. Checkup errors that reason damage or hurt are occasionally called avoidable unpleasant actions that are the damage is a reflection to be due to a therapeutic intervention, not principal patient circumstances. Errors consequential in severe injury or death are considered “sentinel events” by the Joint Commission (Longo, D., Hewitt, J. E., Ge, B., & Schubert, S., 2007). The case study, Appearance May Not is Reality, was the focus of this assignment because of privacy practices. The purpose of this assignment was to identify key ethical and legal issues, determine which elements of the Code of Ethics of the American College of Healthcare Executives (ACHE) would help administrators determine the right course of action, identify potential ethics committee actions, and administrator’s role in preventing and addressing the issues in the aforementioned case study. Protected Health Information is the information that you provide us or we create receive about your health care. PHI contains a patient’s age, race, sex, and other personal health information that may identify the patient (Nationwide Children’s Hospital, 2013). The information relates to the patient’s...
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...to diabetes, but it is a factor to consider. People should practice healthy lifestyles to avoid getting this disease (Bril, Franklin, Backonja, Cohen, Del Toro, & Zochodne, 2011). Most diabetes problems experienced in children is due to either genetic factors or poor eating habits. According to research, cases of diabetes seem to be increasing at a fast rate in America. Estimates also reveal that by the year 2030, the number of people living with diabetes will be double. Treatment procedure for diabetes as suggested...
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...understood, but further studies in methadone maintenance with opioid dependence will prove that methadone maintenance prevents cravings and withdrawal symptoms and helps an addict to maintain their sobriety while trying to overcome their addiction. In this paper the author will discuss the scientific method and several studies that have been conducted on the use of methadone in the treatment of substance abuse. The scientific method is a set of principles and procedures that researchers use to develop questions, collect data and reach conclusions. (Cherry, 2013). In Psychology the goals of the scientific method is to seek and describe behaviors and explain why the behaviors occur. (Cherry, 2013). Researchers also strive to create research that can be used to predict and change human behavior. (Cherry, 2013). The four steps of the scientific method are, (1) forming a testable hypothesis, (2) devising a study and collecting data, (3) examining the data and reaching conclusions and (4) reporting the findings of the study. (Cherry, 2013). All the research articles discussed in this paper used the empirical research method. This type of research is based on experimentation or actual observation; it is conducted to test a hypothesis. The researchers observed and measured the behaviors of the participants using a quantitative research method by collecting data and reporting the data using numbers. (Frankfort-Nachimas, C. & Nachimas, D. 2008). The first study,...
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...Low Energy Laser as a Treatment for Refractory Diabetic Leg Ulcers By Wendy Price Wake Forest University Department of Physician Assistant Studies 4/10/2009 I would like to thank everyone at Coy C. Carpenter library help and reference desks. To Ekatrina Zachry who translated the Russian research papers, thank you is the very least I can say for such an excellent job. I would like to tell my girls how proud I am of them and thank them for their patience, pictures, and prayers. You make it all worth the while. I would also like to thank my mother for her support, coming to help with the girls while I have been in school, and her motherly faith in me that never waivers. Most of all I want to thank my husband Clay Price for being an amazing pillar of strength, encouragement, patience, understanding, and love. I know I COULD NOT have done it without you. UA&F Low Energy Laser as a Treatment for Refractory Diabetic Leg and Foot Ulcers ABSTRACT BACKGROUND: Diabetic leg and foot ulcers often lead to immobility, infection, and amputation, cost $7,000 to $40,000 per ulcer, and erode mental health and QOL. Lasers have been effectively utilized in medicine since the 60’s, from various surgical uses to the treatment of diseases. Although low-energy (also called low-power, low-level, and cold) laser therapy for “biostimulation” (or biomodulation) of ulcer healing has been studied extensively, quality data on diabetic wound healing is rare. This review seeks...
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...infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients on mechanical ventilation, a standard of care was created by the Institute for Health Care Improvement (IHI) in 2004 called the Ventilator Bundle. These measures were...
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...Epidemiology Question 1 1. Case control studies are designed in such a way so as to explore whether exposure can be associated with a particular outcome, such as a disease or certain condition. In these studies, the definition groups are based on the outcome and exposure assessment for potential risk factors. The first step in case control studies is the identification of the case (for example a group of people known to have the certain condition), as well as the control group ( a group that does not have the outcome). The second step is to explore whether some of the subjects in each group were exposed, and how the frequency of the exposure is measured between the case and the control group. Case control studies are basically observational, because there is no intervention taking place, and is a retrospective determination of the exposure to a certain risk factor. Advantages of case control studies • Case control studies are relatively less time consuming, since the disease has occurred in the past, therefore there is no need to assess the disease or condition. • They are an efficient way to study rare cases and diseases or outbreaks of diseases, since they are fast; during an outbreak, the fast examination of certain conditions is required, and a sufficient number of people suffering can be quickly accessed. • They allow a simultaneous examination of multiple conditions and risk factors • Allow the establishment of associations between suspected risk...
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...Evidence Based Practice Task 1 Western Governors University Evidence Based Practice and Applied Nursing Research The nursing topic of interest is bedside handover, which is the concept of conducting shift handover at the patient’s bed instead of doing it at the front desk. Part A The article being analysed is: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal of Clinical Nursing, 22, 192-200. The analysis of the primary research report is done in the form of a graph (figure 1). Each of the four analysis areas is rated within a scale of 1-10; 1 denotes extremely weak while 10 denotes very strong. Table 1 then gives justifications for the rating by explaining why each area of analysis was rated that way in the analysis chart. [pic] Figure 1 Table 1 |A1 Article: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal | |of Clinical Nursing, 22, 192-200. | |A2 Background or introduction |The researchers provided an in depth introduction of the research topic outlining | | |important issues, previous research on the topic and their findings. The introduction | | ...
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