Describe how Florence Nightingale’s contributions to nursing have affected your current nursing practice.

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Describe how Florence Nightingale’s contributions to nursing have affected your current nursing practice.

1. What would Florence think about nursing today?
2. What has changed about nursing?
3. What has not changed about nursing?
4. What future changes do you predict for nursing?
1. Describe how Florence Nightingale’s contributions to nursing have affected your current nursing practice.
Paper should be typed using Times New Roman 12 (or similar) font (Word or Word-compatible document); remember to proofread your paper and correct errors in spelling and grammar. Paper should be uploaded to Populi by the due date.

Logistic Regression in Nursing Practice

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Logistic Regression in Nursing Practice

Logistic regression is used to analyze a wide variety of variables that may surround a singular outcome. For example, logistic regression could be used to identify the likelihood of a patient having a heart attack or stroke based on a variety of factors including age, sex, genetic characteristics, weight, and any preexisting health conditions. The biological systems and issues with which the health care field is concerned represent the kinds of applications for which logistic regression is especially useful.

Logistic regression is used in the health care field for many purposes, including diagnoses, predictions, and forecasting. The three articles in this week’s Learning Resources illustrate the many uses of logistic regression in the health care field. This Discussion allows you to explore the different uses of logistic regression and cultivate a deeper understanding of the application of logistic regression in evidence-based practice. Note: This Discussion takes place in small groups, which should have been assigned by your Instructor.

To prepare:

Review the three articles in this week’s Learning Resources and evaluate their use of logistic regression. Select one article that interests you to examine more closely in this Discussion

Critically analyze the article you selected considering the following questions:

What are the goals and purposes of the research study the article describes?

How is logistic regression used in the study? What are the results of its use?

What other quantitative and statistical methods could be used to address the research issue discussed in the article?

What are the strengths and weaknesses of the study?

How could the weaknesses of the study be remedied?

How could findings from this study contribute to evidence-based practice, the nursing profession, or society?
Write a cohesive response answering the following questions:

In the first line of your posting, identify the article you examined, providing its correct APA citation.

Post your critical analysis of the article as outlined above.

Propose potential remedies to address the weaknesses of each study.

Analyze the importance of this study to evidence-based practice, the nursing profession, or society.
Readings

Course Text: The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence
Chapter 24, “Using Statistics to Predict”

This chapter asserts that predictive analyses are based on probability theory instead of decision theory. It also analyzes how variation plays a critical role in simple linear regression and multiple regression.
Course Text: Statistics and Data Analysis for Nursing Research
Chapter 9, “Correlation and Simple Regression” (pp. 208–222)

This section of Chapter 9 discusses the simple regression equation and outlines major components of regression, including errors of prediction, residuals, OLS regression, and ordinary least-square regression.
Chapter 10, “Multiple Regression”

Chapter 10 focuses on multiple regression as a statistical procedure and explains multivariate statistics and their relationship to multiple regression concepts, equations, and tests.
Chapter 12, “Logistic Regression”

This chapter provides an overview of logistic regression, which is a form of statistical analysis frequently used in nursing research.
Article: Hoerster, K. D., Mayer, J. A., Gabbard, S., Kronick, R. G., Roesch, S. C., Malcarne, V. L., & Zuniga, M. L. (2011). Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers. American Journal of Public Health, 101(4), 685–692. doi:10.2105/AJPH.2009.190892
Retrieved from the Walden Library databases.

This article discusses the results of a study of how many U.S. farmworkers accessed U.S. health care. The study considered this question on several levels—individual, environmental, and policy—and used logistic regression to analyze the multivariate data gathered.
Article: Tritica-Majnaric, L., Zekic-Susac, M., Sarlija, N., & Vitale, B. (2010). Prediction of influenza vaccination outcome by neural networks and logistic regression. Journal of Biomedical Informatics, 43(5), 774–781. doi:10.1016/j.jbi.2010.04.011
Retrieved from the Walden Library databases.

This article describes the methods and results of a neural network study on the effectiveness of the influenza vaccine using historical data in three neural network algorithms. The article also provides a discussion of logistic regression in comparison to the neural network algorithms used.
Article: Xiao, Y., Griffin, M. P., Lake, D. E., & Moorman, J. R. (2010). Nearest-neighbor and logistic regression analyses of clinical and heart rate characteristics in the early diagnosis of neonatal sepsis. Medical Decision Making, 30(2), 258–266. doi:10.1177/0272989X09337791
Retrieved from the Walden Library databases.

This article outlines the procedures and findings of a study on the use of two methods of neonatal sepsis diagnosis: nearest-neighbor analysis and logistic regression analysis. The results indicated that each method generates unique information useful to diagnosis, and therefore both methods should be used simultaneously for improved accuracy of diagnoses…………………..

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Disability and Ageing Theories Comparison

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Task One : Comparing a range of definitions as they apply to Disability and Aging


1.1


  1. Disability according to WHO

According to the World Health Organization,

“ Disabilities is a term that covers impairments, restrictions in participations and limitations in ones activity. An impairment is seen as a problem in body function and it’s structure; a limitation in activity is a difficulty an individual may encounter when performing an action or task; while the restriction in participation is a problem in an individuals life situation.”

As stated on this source, disability is seen as not just a health problem but a complex phenomenon that shows the interaction between features of a persons body and features of society that they live in. It is said that people with disabilities has the same health needs as of those as non-disabled people, like for example disabled people also need immunizations, cancer screenings and treatments for other medical conditions, illnesses or diseases that they might have.


b) Disability according to SSC State Services Commission of NZ

The New Zealand Disability Strategy describes disability as,


“Individuals do not have disability instead what individuals have


are impairments. And these impairments may be physical,sensory,psychiatric,neurlogical, intelletual or other impairments. When people creates barriers the disability process happens because they take no account of people living with impairments in ther world.”

According to this, disability is only a perceived idea , of how non-impaired people view people with impairments. And if people would change their view of impaired individuals then people that has ” disability” would just be people that has impairments and they will be able to function in society if we give them an environment they can work around with.


c) Disability according Government of Western Australia / Disabilities Services Commission

According to the Disabilities Services Commission of Western Australia ,

“ A disability is a condition that continues on to restrict activities in the everyday life. They define disability as:


  • Being attributed to an intellectual,psychiatric,cognitive,neurolgical,sensory or physical impairment

  • Permanent or may likely be permanent

  • Chronic or acute

  • Reduced capacity of an individual to cmmunicate, interact socially, learn, move and wil need continouos support.”

As stated on this source , disability is an impairment that will restrict a persons movement and functioning that is caused by a multitude of physiological and external factors. It is said that most restrictions that people with disability may encounter can be overcome by using appropriate tools and utilizing services specifically designed for their impairments.


  • In your own words compare those definitions and identify the similarities and differences between them

According to the sources I have used, they define disability as being attributed to a multitude of impairments such as an intellectual, psychiatric, cognitive, neurological, sensory or physical impairment or a combination of those impairments that makes them unable to perform certain tasks effectively or none at all. It is stated that a person with a disability has the reduced ability to communicate , interact , learn and move and will be needing assistance in their daily lives. But the sources also gave different views and definitions on how they view disability.

One of those differences is that according to the State Services Commission of New Zealand, a disability is a process and not a condition, therefore a person is disabled only because of the perception of society and their attitudes towards people that have impairments. Society does provide them an environment in which they can become productive and function with the abilities they possess, instead society views them as people that cannot contribute and has no useful abilities.

Another difference is that according to WHO disability is categorized under two terms, which are impairment and limitations. Impairment is seen as a problem in the way the body, parts of the body or a specific part of the body fail to function, while limitation is seen as difficulty in performing certain tasks or actions.

The Disabilities Services Commission of the Government of Western Australia see disability as being chronic or a condition that has endured and will endure for a long time and acute which means an abrupt onset or occurrence of an impairment. They view disability as being one of permanent or temporary nature.


1.2 Comparing 3 (three) definitions of aging


  1. Aging according to US Department of Health and Human Services, National Institute on Aging

According to the National Institute on Aging of the US Department of Health and Human Services aging is defined as ,

“ Aging is a reflection of all the changes that occur all throughout our lives. As we grow, develop and mature. For young people aging wil be exciting because they will have late bedtimes and longer curfew hours. And during middle age there might be a grey hair or two. For a marathon runner he will not be able to run as fast like when he was 20 now that he is 60. There are varying factors that will affect aging.”

As defined in this source, aging is a reflection of all the changes that happens through the course of our entire life. The growth, development and maturity which thus entails that aging in a broad sense is a change in our biology, our psychology, our environment and our cognitive abilities.


b) Aging according to senescence.info , author Joao Pedro de Magalhaes, PHD

According to the author on senescence.info ,

“ Aging can be just a passing of time and seen a just a normal biological process of getting older. Some people call this senescence. And some have defined it as a progress in which humans will inevitably die.


Aging is viewed as a complex process that is composed of three features:


1) Increase in likelihood of death as we age; 2) changes within the body that will lead to deterioration of internatl functions and 3) the increased risk of catching infections and diseases as people age. It is a progressive decline in bodily functions, and it is an intricate process of life.”

As defined on this source, aging is described as leading to the process of death or mortality due to the biological process of growing older, as the body loses the ability to function with efficiency and it becomes vulnerable to environmental factors including illnesses and diseases.


c)


Aging according to Age and Aging Journal , Auckland Library , Digital Library

According to the journal , “ Aging is the result of a complex interaction of the genetic make up and the environment we live in. As people age it is but normal to suffer certain diseases and illnesses so we cannot discount it as a factor in the aging process. Aging may also be explained as the body’s response to stress that can lead to physical and chemical damage, infections and trauma. Aging can also be attributed as a by product of action in the genes or the natural selection process that deteriorates as we age.”

According to this source , aging is defined as the chemical processes that occur within the cellular level of our bodies and the various factors of genes, gene mutations and the different phenotypes which affect how our bodies change in accordance with the cellular changes that occur during the Aging process.


  • In your own words compare those definitions and identify the similarities and differences between them

According to the sources I have used, they define Aging as a complex process affected by varying physiological, biological, environmental and social factors that contribute on how Aging progresses. They state that Aging is not only about the external characteristics of our physicality, like the changing color of our hair or the wrinkling of our skin, but a more in depth analysis reveals that a lot of factors that we encounter in our lives affect the Aging process.

Some differences on how the sources define Aging can be seen with how the National Institute of Aging view it in a more positive way. They state that Aging is attributed to how a person grows, develops and matures through the course of life. Therefore, they view Aging as a state of mind , an accumulation of knowledge and experiences as one goes through life.

However according to Joao Pedro de Magalhaes, PHD on senescence.info Aging is more on the most basic and primal note. According to his research, Aging is a gradual and progressive decline in how well our body functions over time, our body’s susceptibility to illnesses and diseases as we grow older because our immune system will weaken as we age and that Aging is an inevitable path leading towards death.

The Age and Aging Journal defines Aging on a cellular level. Stating that as part of Aging process diseases and illnesses contribute on how we age. And the level of Aging is widely affected by our genes, how genes mutate and phenotypes which affect how our body will change according to the cellular changes inside us during the Aging process.


1.3 Comparing theories of disability and aging


Disability Theory


The Medical Model

The Medical Model defines disability as being caused by an illness or medical condition. It is said that disability is directly caused by trauma, disease, or other health conditions and people that have disabilities need sustained medical care provided by professionals.

The Medical Model promotes the view that a disabled person is someone who is dependent on others and needs care to be provided to them.


Aging Theory


Psychosocial Theory

Psychosocial theories of Aging states that Aging is correlated to human development such as an individuals change in cognitive functions, behaviours, roles, relationships and coping ability and social changes. This theory does not describe how older people could be treated or what the social changes are but they describe what Aging implies and factors important to the care of older people can be derived from this factors.

  1. Age – is the period in time in which a person has been living
  2. Gender – refers to the roles, behaviours, activities and attributes that society deem appropriate for a man and a woman
  3. Class – is an individual or groups position within hierarchal social structure. It is associated with socio-economic status including variables such as occupation, education, income, wealth and place or residence.

4. Ethnicity – refers to a persons language, culture, history, socio-economic and political factors, geographic origin of ancestry, nationality and beliefs and traditional practices.


1. AGE


Age in relation to the Medical Model in Disability

Age is the period in time in which a person has been living, and according to the Medical Model a disability is caused by trauma, disease or other health conditions. The implication of age in relation to the Medical Model is that, as a person grow older or “age” our body’s immune system becomes weaker as do our bones and muscles, this makes older persons susceptible to infections and diseases therefore causing disability. For example a 20 year old persons lung is much more stronger than an 85 year old, therefore if both of them are exposed to pneumonia there is a high probability that the 85 year old person will die and the 20 year old will just need some medications and he will be alright.


Age in relation to Psychosocial Theory in Aging

Age is the period in time in which a person has been living, and according to the Psychosocial Theory of Aging , it is said that Aging is correlated to the human development including the change in cognitive functions, behaviours, roles, relationships and coping ability and social changes. The implication of age in relation to the Psychosocial Theory of Aging is that as a person grows older so does his/her abilities and knowledge, collection of memories and emotions that shape a persons personality and how he/she views life, life experiences and the social circle they move around in contribute to how a person ages.


  1. GENDER


Gender in relation to the Medical Model in Disability

Gender refers to the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for men and women, and according to the Medical Model a disability is caused by trauma, disease or other health conditions. The implication of gender in relation to the Medical Model is that since society dictates what should and should not be done according to gender, the diseases and types of trauma that a male and female will have that will lead to disability will be different for a male and a female. For example in terms of trauma, in Saudi Arabia females are not allowed to drive vehicles and only males are allowed to, therefore there will be a markedly increased number of trauma cases for male leading to disability than females.


Gender in relation to the Psychosocial Theory in Aging

Gender refers to the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for men and women, and according to the Psychosocial Theory of Aging , it is said that Aging is correlated to the human development including the change in cognitive functions, behaviours, roles, relationships and coping ability and social changes. The implication of gender in relation to the Psychosocial Theory is that a male and female will have different life experiences, developments in cognitive functioning, behaviours, roles relationships and coping ability and social changes so the way that they will age will be different from each other. One example of this is regarding roles and relationships, coping ability and social changes in a Muslim culture like Saudi Arabia. A male can interact with anyone they want to interact with and there is no restriction regarding this, but females are not allowed to talk to males that are not their husband or immediate family member. Therefore the females have less exposure to the outside world and their coping abilities in social situations will be poor compared to the males and this will reflect on how they age.


  1. CLASS


Class in relation to the Medical Model in Disability

Class is an individuals affiliation within a social hierarchical structure that is associated with an individuals socio-economic status. and according to the Medical Model a disability is caused by trauma, disease or other health conditions. The implication of class in relation to the Medical Model is that, the type of trauma, disease or other health condition leading to disability that a person may have will depend on where he is in the socio-economic structure. An example of this will be a person of low socio-economic background contracts diabetes. Since he is of low socio-economic status he will be unable to seek medical attention, purchase and take medications, and eat a healthy diet, he can suffer from kidney failure as a complication and therefore be unable to work and this will cause disability. Whereas a person of high socio-economic status can easily access medical care and attend to all his needs and his diabetes would not lead to complications and become a disability if he will follow medical advice.


Class in relation to the Psychosocial Theory in Aging

Class is an individuals affiliation within a social hierarchical structure that is associated with an individuals socio-economic status, and according to the Psychosocial Theory of Aging , it is said that Aging is correlated to the human development including the change in cognitive functions, behaviours, roles, relationships and coping ability and social changes. The implication of class in relation to the Psychosocial Theory is that, the quality of life of a person , of how he ages and develops through his life will depend on his socio-economic status.For example, a person of high socio-economic status is said to be a person who can age well, because of financial stability he is able to access services that are not available to a person of low socio-economic status. He has the capability and capacity to sustain his cognitive improvements and sustain all levels of development throughout his life. His life experiences will be enriched and he can achieve quality Aging.


  1. ETHNICITY


Ethnicity in relation to the Medical Model in Disability

Ethnicity refers to a persons language, culture, history, socio-economic and political factors, geographic origin of ancestry, nationality and beliefs and traditional practices, and according to the Medical Model a disability is caused by trauma, disease or other health conditions. The implication of ethnicity on the Medical Model is that the type of disease or trauma a person may have will depend on his ethnical background. There are certain diseases that will lead to disability that affects only a certain ethnic group due to genetics, diet and cultural practices. For example people of African origin has prevalent cases of sickle anemia, instead of a round red blood cell , the red bloods are shaped like a crescent moon, which causes them to lump together and block blood vessels which causes severe pain to the person affected. The pain they experience usually lasts for hours or some even for days.


Ethnicity in relation to the Psychosocial Theory in Aging

Ethnicity refers to a persons language, culture, history, socio-economic and political factors, geographic origin of ancestry, nationality and beliefs and traditional practices, and according to the Psychosocial Theory of Aging , it is said that Aging is correlated to the human development including the change in cognitive functions, behaviours, roles, relationships and coping ability and social changes. The implication of ethnicity in relation to aging is that how a person ages is affected by a persons ethnical background. Because people from different parts of the world have practices that are unique to them, this will affect their development and their aging process. How they live their day to day lives and how they deal with the daily experiences will vary according to their culture.


References

WHO. (2014).

Disabilities.

Retrieved from

http://www.who.int/topics/disabilities/en/

State Services Commission of NZ. (2014).

Chapter One: Defining disability.

Retrieved from

http://www.ssc.govt.nz/node/1671

Disabilities Services Commission , Government of Western Australia. (2014).

What is Disability.

Retrieved from

http://www.disability.wa.gov.au/understanding-disability1/understanding-disability/what-is-disability/

National Institute on Aging, US Department of Health and Human Services. (2011).

Biology of Aging, What is Aging?.

Retrieved from


http://www.nia.nih.gov/health/publication/aging-under-microscope/what-aging

De Magalhaes, J.P. (2013)

What is Aging

. Retrieved from

http://www.senescence.info/aging_definition.html#Demographic_Measurements_of_Aging

Dyer, Christopher A.E., and Alan J. Sinclair. (1998). The premature ageing syndromes: insights into the ageing process.

Age and Ageing 27.1 (1998): 73+.

GALE|A21113303 .

Student Resources in Context.

Retrieved from


http://0-ic.galegroup.com

.

www.elgar.govt.nz/ic/suic/AcademicJournalsDetailsPage/AcademicJournalsDetailsWindow?failOverType=&query=&prodId=SUIC&windowstate=normal&contentModules=&mode=view&displayGroupName=Journals&limiter=&u=auclib&currPage=&disableHighlighting=false&displayGroups=&sortBy=&source=&search_within_results=&p=SUIC&action=e&catId=&activityType=&scanId=&documentId=GALE|A21113303

WHO. (2014).

Gender

. Retrieved from

http://www.who.int/gender/whatisgender/en/


  • Jaqueline Villaflores

Peer review journal article that integrates nursing theory and nursing management.

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Peer review journal article that integrates nursing theory and nursing management.

Discussion 4 Unit 2

Complete a library search for a peer review journal article that integrates nursing theory and nursing management. Present the article and discuss the nursing theory used, the benefits of nursing theory in management and any weaknesses you identify in the article.

Responses should be at least 500 words long, integrate key concepts from the weekly readings and include specific examples of how the concepts can be applied to your work environment. Attach a copy of the article, or e-mail your article to the instructor for posting.
Post response no later than Thursday. Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position. Please see grading rubric for additional requirements

Students are expected to:
1. Post an initial substantive response of 200-250 words to each question.
2. Read postings and engage in the discussion boards 4-5 days per week.
3. Respond to at least two other student’s postings with substantive comments.
Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
The postings should be at least one paragraph (approximately 100 words) and include references as indicated by the instructor.
4. References and citations should conform to the APA 6th edition.
Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.
Plagiarism is never acceptable – give credit when credit is due – cite your sources

Discuss pathophysiology, physical examination, and management strategies for the illness.

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Discuss pathophysiology, physical examination, and management strategies for the illness.

For your assigned topic discuss pathophysiology, physical examination, and management strategies for the illness. Meningococcal Disease Please use three scholarly journals within past 5 years. Get a 10 % discount on all orders. Use the following coupon code : SUPREM1

Effective Approaches in Leadership and Management

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Effective Approaches in Leadership and Management

Paper instructions:
1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1) Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.

2) Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.

3) Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.

4) Use at least two references other than your text and those provided in the course.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Reflective Essay on Dementia

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My first administrative position in mental health was working on a Geriatric Psychiatric unit of the local hospital. Many of the patients were elderly patients with Alzheimer’s. This was my first experience with Alzheimer’s disease and the effects it has on their families. “Alzheimer’s is the most common type of dementia and is incurable, degenerative, and terminal” (Wikipedia) . Symptoms of Alzheimer’s begin slowly and become worse until they interfere with daily life and patients are unable to even carry on conversations. Families become caregivers for their loved ones who don’t know who they are any more. The prognosis is not good for patients afflicted with this type of dementia but researchers continue to look for new treatments and possible preventions. A few of the Alzheimer’s patients I worked with on the Geriatric unit are very memorable. There was a gentleman who was in the moderate to severe stage of the disease. His job for most of his life was that of a hospital administrator.

My office door was always open and some patients would wonder in time and again. My office must have triggered something in him because he would come in and need to sign papers. He would sit in my office for hours and sign papers. Another patient was a woman who had 12 children. She was always wondering the unit looking for her babies. The nurses bought her a baby doll and she carried it everywhere and it also calmed her down. Another aspect of Alzheimer’s is “sundowners syndrome”. Many of the Alzheimer’s patients would start to get agitated between 4:00 and 5:00 p.m. They would become more aggressive, oppositional and agitated. “Sundowners syndrome is an increased time of memory loss, confusion, agitation, and even anger. For family members who care for Alzheimer’s patients, witnessing an increase in their loved one’s symptoms of dementia at sunset can be nothing short of troubling, if not also painful, frightening, and exhausting” (Sundowners Syndrome).

Alzheimer’s is not a new disease. “Alzheimer’s was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906. In 1901, Alzheimer observed a patient at the Frankfurt Asylum named Mrs. Auguste Deter. The 51-year-old patient had strange behavioral symptoms, including a loss of short-term memory. This patient would become his obsession over the coming years. In April 1906, Mrs. Deter died and Alzheimer had the patient records and the brain brought to Munich where he was working at Kraepelin’s lab. Together with two Italian physicians, he would use the staining techniques to identify amyloid plaques and neurofibrillary tangles” (Wikipedia). “Amyloid plagues are extracellular deposits that consist of a dense core of a protein known as B-amyloid, surrounded by degenerating axons and dendrites, along with activated microglia and reactive astrocytes, cells that are involved in destruction of damaged cells. Neurofibrillary tangles consist of dying neurons that contain intracellular accumulations of twisted filaments of hyperphosphorylated tau protein” (Carlson, 2008). These abnormal structures are also found in brains of patients with Down syndrome. Unlike Down syndrome, Alzheimer’s is a progressive degenerative disease that gradually destroys a person’s memory and daily functioning. Currently Alzheimer’s is diagnosed by symptoms, and only confirmed by brain examination after death.

There are warning sides of Alzheimer’s disease that include memory loss that disrupts daily life. Challenges in planning or solving problems when there were no problems before. Difficulty completing familiar tasks or leisure activities they a person used to do. Confusion with time and place, which is what most people know about Alzheimer’s. This is when family members forget where they are going or days of activities. Trouble understanding visual images and spatial relationships or new problems with words speaking or writing. Misplacing things and the inability to retrace steps. Decreased or poor judgment and withdrawal from work and social activities. Changes in mood and personality, which is another warning sign that most people are also familiar with from media, etc. Grandma turns from sweet to irritable (Stages and Warning Signs of Alzheimer’s). The Alzheimer’s Association is a strong national organization that supports and funds Alzheimer’s research. Their website has a vast amount of information on symptoms, treatment, prevention and research of this disease. Taken from their website there are seven stages of Alzheimer’s. They include: Stage 1 where there is no impairment. Stage 2 there is very mild decline. Stage three there is mild decline. Stage four there is moderate decline. Stage five there is moderately severe decline and stage six and stage seven there is severe decline and very severe decline (Stages and Warning Signs of Alzheimer’s).

The current major treatment for Alzheimer’s is medication management and each stage of Alzheimer’s requires a different medication. Mild to moderate Alzheimer’s is treated with cholinesterase inhibitors. These types of medications are prescribed because they may help delay or prevent the symptoms from becoming worse for a time and also help manage behaviors. “The medications include: Razadyne (galantamine), Exelon (rivastigmine), and Aricept (donepezil). Another drug, Cognex (tacrine), was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns” (Alzheimer’s Disease Medications Fact Sheet, 2010). Most people have heard of Aricept because is used often and advertised on the media more so than others. Moderate to severe Alzheimer’s is treated with a drug that regulates glutamate, an important brain chemical. The medication known as Namenda (memantine), an N-methyl D-aspartate (NMDA) antagonist. Aricept has also been approved by the FDA to treat moderate to severe Alzheimer’s. These drugs main effect is to delay progression of some of the symptoms and they may allow patients to maintain certain daily functions a little longer than they would without the medication. The medication may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers (Alzheimer’s Disease Medications Fact Sheet, 2010). There is research going on to provide diagnosis by a simple blood test, this was reported by American researchers just last month. Also, other researchers have shown spinal fluid tests, which require a spinal tap, can detect early changes that signal the onset of Alzheimer’s. “Imaging companies such as privately held Avid Radiopharmaceuticals, General Electric’s GE Healthcare and Germany’s Bayer are racing to finish clinical trials on new agents that can make brain lesions called plaques visible on positron emission tomography or PET scanners” (Anonymous, 2010). Researchers also are looking at any possible prevention or slow down of the disease. “Currently at Rush University is leading a nationwide clinical trial of a nutritional drink to determine whether it can improve cognitive performance in people with mild to moderate Alzheimer’s. The study follows recently released results from an earlier trial conducted in Europe showing that the drink, called Souvenaid, improved verbal recall in people with mild disease who were followed for three months” (Anonymous., 2010). Alzheimer’s affects approximately 10 percent of the population above the age of 65 and almost 50 percent of people over the age of 85 years (Carlson, 2008).

The number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by mid-century. A recent report from the Alzheimer’s Association states that the cost of Alzheimer’s to the United States will be $20 trillion over the next 40 years. “Changing the Trajectory of Alzheimer’s Disease: A National Imperative shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer’s from 2010 to 2050 will exceed $20 trillion, in today’s dollars” (Report: Alzheimer’s disease to cost United States $20 trillion over next 40 years, 2010). Statistics taken from the Alzheimer’s Association break it down as follows; “Alzheimer’s disease costs business $24.6 billion in health care. In the US 7 out of 10 people with Alzheimer’s live at home where 75% of costs are absorbed by the family. The remaining 25% of care costs cost an average $19,000 a year. It is estimated that Alzheimer’s caregivers cost business $36.5 billion. This includes the costs of absenteeism and lost productivity. The average cost of a nursing home in the US is $42,000 a year. However in some areas those costs can be at least $70,000. Medicare costs for beneficiaries with Alzheimer’s disease were $91 billion in 2005. Medicare costs are expected to increase by 75% to $160 billion in 2010. Medicaid expenditures on residential dementia care were $21 billion in 2005. These costs are estimated to rise by 14% to $24 billion in 2010″( (Kennard, 2010). The stress of caregivers for loved ones with Alzheimer’s is high. The frustration and challenges of caring for an adult who no longer complies with reasonable requests is a daily consequence of a loved one with Alzheimer’s. There are many support groups and resources for caregivers. Some tips for managing an Alzheimer’s patient is to have patience, be flexible, reduce frustration, reduce choices, reduce distractions to create a safe environment (Research, 1998-2010). Patience and flexibility are easy to figure out. Patience because a patient with Alzheimer’s will be oppositional at times, will not know their caregiver at times as well as not remember family members. The Alzheimer patient’s mood and reactions to daily tasks will change sometimes daily as the disease progresses. Flexibility with caring for Alzheimer’s patients is tied into their changing needs and abilities from day to day. Reducing frustration, choices and distractions would be like raising a toddler. Not too many choices or distractions for them to be overwhelmed with. A safe environment is pretty clear and we hear about Alzheimer’s patients wandering off reported on the news more often. Alzheimer’s patients who have been left in an unsecured house or got into a unlocked car. Doors should always be locked so the Alzheimer’s patient is unable open or figure out how to open. The car is easy to figure out, keep it locked! Take the car keys are keep them on you or hidden. There was a poem on the Geriatric unit wall where I worked. The author is unknown and it is taken from Coach Frank Broyles ‘Playbook for Alzheimer’s Caregivers’.   The poem is a good reminder of what Alzheimer’s is all about and a good conclusion to this report.       Do not ask me to remember. Don’t try to make me understand. Let me rest and know you’re with me. Kiss my cheek and hold my hand. I’m confused beyond your concept. I am sad and sick and lost. All I know is that I need you, to be with me at all cost.  Do not lose your patience with me. Do not scold or curse or cry. I can’t help the way I’m acting, can’t be different though I try. Just remember that I need you, that the best of me is gone. Please don’t fail to stand beside me, love me till my life is done.

Related content

determining how resources should be allocated for an aging population and end-of-life care

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Write 2-3 page

explanation of the ethical standards you believe should be used in determining how resources should be allocated for an aging population and end-of-life care. Then, provide an analysis of the ethical challenges related to the preparation for the provision of such health care.

  • Ethical Issues with an Aging Population

  • Ethical Standards that Should be Used in Resource Allocation

  • Analysis of Ethical Challenges in Preparation for Such Health Care



References

  • Support your information with references. (

    at least 2 references)








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” From the information below, the consensus assumptions and objective worksheet, and the consensus statistical budget worksheet you developed, prepare a consensus supplies and other expense worksheet and budget for the six departments. Laboratory spent $705,000 on supplies in 2012, $731,000 in 2013 and $740,000 in 2014. This was the cost incurred for supplies to perform tests at the hospital. It spent $710,000 to perform tests outside the hospital and a total departmental cost to include salaries of $2,962,000 in Fiscal 2014.

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”
From
the information below, the consensus assumptions and objective worksheet, and
the consensus statistical budget worksheet you developed, prepare a consensus
supplies and other expense worksheet and budget for the six departments. Laboratory
spent $705,000 on supplies in 2012, $731,000 in 2013 and $740,000 in 2014. This
was the cost incurred for supplies to perform tests at the hospital. It spent
$710,000 to perform tests outside the hospital and a total departmental cost to
include salaries of $2,962,000 in Fiscal 2014.

Emergency/Outpatient
budgeted $271,000 for supplies in 2014. This figure was $22,000 over the
budget. It spent $230,000 on supplies in 2013 and $215,000 in 2012.Nursing
was budgeted for $2,202,000 in medical supplies in 2014. They were budgeted
$1,981,000 in 2013 and $1,858,000 in 2012. In 2014, many items were converted
to disposables.Pharmacy
spent $884,000 on drugs in 2012, $925,000 in 2013, and $938,000 in 2014.Radiology
spent $605,000 on x-ray supplies in 2012. It is currently spending on budget at
$625,000 for supplies in 2014. The department is changing its supplies
vendor in 2015, which is expected to cost 10% more than present supplies. Total
budgeted supplies for Radiology in 2013 is $611,000. Ten percent (10%)
of the Radiology volume comes from outpatients.Dietary
is budgeted for $438,745 in food and supplies for 2014. Last year they spent
$432,440 and in 2012, $421,000. Food prices have been increasing at a rate of
about 7.5%.

Why Aspirin is Not Beneficial in Non-Diabetic Patients

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Understanding the serious threat that cardiovascular disease poses and the various risk factors for developing this disease is fundamental to a patient’s health. Risks for cardiovascular disease can be due to a patient’s family history, gender, or age, but could also be indicative of their daily lifestyle. These factors can include hypertension, obesity, hyperlipidemia, unhealthy diet, and tobacco use. Prophylaxis with aspirin therapy or non-pharmacological treatment is a method in which patients can prevent adverse cardiovascular events, such as myocardial infarction or stroke.

1

Aspirin is a cyclooxygenase-II inhibitor that acts on the coagulation cascade leading to decreased thrombin activity and decreased clot formation as a result. It can also work to reduce inflammation, fever, and pain. It is vital to use aspirin in the secondary prevention of cardiovascular disease because the patients are at such a high risk of additional events. However, an ongoing debate is whether primary prevention with aspirin is beneficial in non-diabetic patients. Determining when to prescribe aspirin is important to ensure consistent guidelines across the board and to maximize patients’ safety and overall health since cardiovascular disease is the number one cause of death in both men and women.

2

Trials have been performed to determine whether aspirin is efficacious in certain patient populations, but no definite answer has been found in regards to primary prevention. The ARRIVE trial, the ASPREE trial, and lastly the Women’s Health study further explore the benefits and risks of using aspirin for primary prevention. From the primary literature, the use of aspirin in non-diabetic patients for the primary prevention of cardiovascular disease should not be given due to bleeding risks and increased death rates due to age.

The Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) trial was a double-blind, randomized controlled trial that studied the efficacy of 100 mg enteric-coated aspirin daily compared to a placebo. It was a six-year study that followed 12,456 patients over a total of nine doctor’s visits.

3

These patients, both men and women, were 55 years or older with 2 or more cardiovascular risk factors. These risk factors could include high blood pressure, high cholesterol, or a positive family history of cardiovascular disease. Most patients had an ASCVD risk score between 10-20%, which was indicative of their risk factors. However, patients were excluded if they had diabetes, high bleeding risks, history of a vascular event, or required antiplatelet therapy. The primary outcome was the time to cardiovascular death, myocardial infarction, stroke, unstable angina, or transient ischemic attacks.

3

As mentioned above, the trial was a double-blind, randomized control trial, which decreases bias because neither patient nor researcher knows which medication the patient is receiving so results will not be skewed. Also, patients with diabetes were excluded from the study, which proved to strengthen this trial because diabetes itself is a major cardiovascular risk factor. By only studying non-diabetics we are able to see if aspirin can truly lower cardiovascular risks without the presence of a major factor. ARRIVE included women and older age individuals who were at risk of developing cardiovascular disease within this trial, which was a strength that separated them from other trials performed in the past. The trials also performed comprehensive analyses through intention-to-treat and per protocol testing. This allowed thorough testing and follow-up with patients from beginning to end to ensure the most accurate conclusions could be determined even if the patients did not complete the full duration of the study.

The ARRIVE trial’s funding is considered a weakness since Bayer manufactures aspirin and funded this trial. The trial did not seem to find statistically significant differences between the aspirin group and placebo group, but how can one trust these results if Bayer was responsible for some portions of the study design, the data collection, analysis and interpretation? In addition, they also had an independent statistician and were responsible for the final decision on whether to publish the study or not. Would Bayer release study results that poorly demote their product, which would ultimately prompt questions of bias within this study and how accurate the conclusions truly are? At first, the data seemed to be promising and consistent. However, upon further investigation, the data was sporadic, which proved to be a weakness. At first glance, the Kaplan-Meier curves regarding the cumulative incidence of the primary outcome would lead one to believe the lines showed separation, meaning there were statistically significant differences between the two groups, which were in favor of aspirin. But, these curves were misleading in that each y-axis only increased by two percent intervals. Overall, the readers must ask themselves how applicable this data is based on the small intervals of the y-axis. In addition, the Forest plots were also inaccurate upon further interpretation. For example, the cardiovascular disease risk score quartiles show individuals with risk scores less than 21.6% favoring aspirin, while the group with a risk percent greater than 21.6% favoring the placebo.

3

The overall confidence interval should be on the far side of the aspirin side, however it is very close to favoring placebo. Realistically, the individuals with a greater cardiovascular risk percent should favor aspirin if the lower percent did, but this was not the case. Therefore, this prompts the reader to inquire why there would be a disconnection between the data. Is the data skewed from inconsistencies in data collection and analyses or did Bayer skew the data to provide better results for themselves? Perhaps Bayer is trying to hide results about their product to prevent backlash or decrease in sales. Additionally, there were not enough events to reach the previous power wanted of 91%, so after receiving the data they had to adjust their protocol to adjust for a power of 80%.

3

External validity is not strong with per-protocol population, but this population did show statistical significance regarding myocardial infarctions. The intention-to-treat population has a stronger external validity because patients will not always be compliant, but this population did not show a statistical difference. Which is more important?

Overall, the ARRIVE trial determined aspirin is not an effective therapy in moderate risk patients for primary prevention of cardiovascular disease. Patients treated with aspirin had no reduction in the risk of cardiovascular incidences compared to the placebo. The aspirin treatment group also showed increased rates of gastrointestinal bleeding, 61 patients out of 6270 total, compared to the placebo group, 29 of the 6276 patients.

3

Prescribing aspirin for primary prevention would only harm the patient due to bleeding risks with no benefits of reducing the risk of cardiovascular events. The trial’s funding bias and skewed data also further dispute the idea that aspirin should be given to individuals for primary prevention.

The Aspirin Reducing Events in the Elderly (ASPREE) trial was a randomized, double-blind study that studied whether low dose aspirin could extend the life of healthy elderly individuals. Men and women who were 70 years or older and were compliant when taking pills due to a 1 month trial were included in this study.

4

They could not have cardiovascular disease, dementia, high bleeding risks, anemia, disabilities, or were expected to die within 5 years. Exclusions included use of anticoagulants or antiplatelet therapy and blood pressure higher than 180/105 mmHg.

4

Once they were eligible, the 19,114 participants were then randomized and received either aspirin 100 mg or placebo.

4,5

The primary outcome for this trial was a composite of death, dementia, or persistent disability.

The National Institute on Aging was the primary financial resource, which strengthens this study’s findings since it is a non-biased source as opposed to Bayer funding the ARRIVE trial. This study also set clear, distinct standards as to what they considered bleeding to be.

4

This was a major strength and improved the study’s accuracy and results. The sample size in which this study drew results from was vast, which is another strength. Additionally, this study used intention-to-treat and Cox regression to analyze the data.

4,5

The confidence intervals were not adjusted, thus concluding the data is accurate and raw, unlike the ARRIVE trial, furthering increasing the strength of this study.

The National Institute on Aging stopped the trial early because the data already collected and analyzed proved there would be no benefit regarding the primary outcome in continuing treatment.

5

Concerning major bleeding, the aspirin group showed significantly higher results compared to the placebo group and the risk of major hemorrhaging increased with continued use of aspirin (hazard ratio: 1.38, confidence interval: 1.18 to 1.62, p< 0.001).

4

The study concluded that individuals who were over 70 years old should not take aspirin due to the high mortality rates and increased bleeding risks. In patients who received aspirin, there were 1.6 excess deaths per 1000 years after 4.7 years compared to the placebo.

4,5

Previous trials have not found results similar to this statistic, thus one should question how accurate the results prove to be. The median age for the participants was 74 years old, which is considered a weakness and limitation. One of the risk factors for cardiovascular disease is age; therefore, only studying individuals who are already at risk of developing the disease could have skewed the data results. Out of the 19,114 participants, 1052 individuals died during the trial.

5

Did the individuals die of natural causes or was it from the aspirin? To determine this and to eliminate bias, an outside adjudicator with no knowledge of which patient was in which group was responsible for determining the cause of death, which was considered a strength.

5

Not only was the adjudicator an unbiased source, it also helped reduce limitation from the median age. Adherence was noted to be an issue towards the end of the trial, which could have skewed data results and weakened the trial’s conclusions. Was forgetfulness with age becoming an increasing problem for these individuals who were deemed prior to the study free of dementia or did they begin noticing adverse side effects and stop taking the medication? Despite its few weaknesses, the ASPREE trial proved to be a strong trial that discouraged the use of aspirin in the elderly for primary prevention due to increased bleeding risks and death rates.

The Women’s Health Study was a two-by-two factorial, randomized control trial that compared the combination of aspirin and vitamin E to placebo in the primary prevention of cardiovascular disease in 39,876 healthy women.

2

This study sought to determine the lowest dose of aspirin one could take to receive cardio-protective effects, while also reducing bleeding risks. Women who were 45 years or older were eligible if they had no history of cancer, cardiovascular disease, or another major illness. They could not be taking more than one dose of aspirin or vitamin supplements (A, E, or beta-carotene) per week. These women also could not be on any anticoagulants or corticosteroids. The women were followed for 10 years to assess for a combination primary endpoint of myocardial infarction, stroke, or death as a result of cardiovascular issues.

2

These individuals took aspirin and vitamin E every other day. This could create complications with compliance because the patient has to remember what pills to take on what specific day, which could skew results. The Women’s Health Study not only received a grant from Bayer, but also received their drug supply from them. As with the ARRIVE trial, this causes major flaws and bias within the study data. How can one trust these results when the manufacturer is once again funding the study and supplying the drug?

The greatest strength of this study was the fact they used only women. For example, while there’s no difference in myocardial infarction with aspirin, the big difference is in stroke. This is significant because women have more strokes than men.

1

This can also emphasize how important it is to study different populations like gender when it comes to drug therapy. In addition, their population size was vast. This gave them the ability to have a high power to detect differences in subgroups. Cox regression and intention-to-treat analyses were performed for all primary endpoints, which helped to ensure accurate results.

The Women’s Health Study showed that aspirin had more of an effect on the elderly population seeing as they had one third of the cardiovascular events. Bleeding in the aspirin group was statistically significant when compared to the placebo group (p = 0.02). The transient ischemic attack was also significant, as well as the overall stroke risk. Once again, this study proves aspirin causes more harm than benefit in the treatment of primary prevention of cardiovascular disease.

After reviewing the three trials, it is obvious aspirin should not be used in the primary prevention of cardiovascular disease. Not only does it increase the risk of bleeding, but it also causes increased numbers of mortality. Additionally, it shows no risk in reducing the occurrence of cardiovascular events. Instead of having these patients take aspirin, which causes more harm than benefit, doctors should focus on having these individuals make lifestyle modifications to reduce their risk of developing cardiovascular disease. A healthy and nutritious diet with low salt intake and physical activity can significantly reduce one’s risk. In conclusion, prophylaxis with non-pharmacological treatments will provide the most benefit in patients compared to prophylaxis with aspirin in patients needing primary prevention for cardiovascular disease.


References:

  1. Sergio Coccheri. Use and misuse of aspirin in primary cardiovascular prevention.

    Clinical Medicine Insights: Cardiology

    . 2017;2017(11):1179546817702149. doi: 10.1177/1179546817702149.
  2. Ridker PM, Cook NR, Lee I, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.

    The New England Journal of Medicine

    . 2005;352(13):1293-1304. doi: 10.1056/NEJMoa050613.
  3. Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomised, double-blind, placebo-controlled trial.

    The Lancet

    . 2018;392(10152):1036-1046.
  4. McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly.

    The New England Journal of Medicine

    . 2018;379(16):1509-1518. doi: 10.1056/NEJMoa1805819.
  5. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly.

    The New England Journal of Medicine

    . 2018;379(16):1519-1528. doi: 10.1056/NEJMoa1803955.