A Study on the Effect of Artesunate on HT-29-AK Cancer Cells

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The possible cytotoxic effect of Artesunate on the survival factors and the concentration of HT-29-AK cells over different incubation periods and its therapeutic implications.

The possible cytotoxic effect of Artesunate on the survival factors and the concentration of HT-29-AK cells over different incubation periods and its therapeutic implications.


Background:

HT-29-AK are cancer cells, Artesunate is an antimalarial compound which could possibly be used as an anti-tumour agent. The present study attempts to confirm the incubation period most effective in decreasing the concentration of HT-29-AK cancer cells.


Aim/Hypothesis:

This experiment tests the effect of Artesunate on the E-Cadherin mRNA expression, VEGF-alpha and beta mRNA expression, Survivin and on caspase-3 expression.


Methods:

96 well plates were used and HT-29-AK cells were incubated at different concentrations over different time periods to examine the effective concentration and incubation period. The E-Cadherin mRNA expression was measured using immunocytochemistry and the Survivin and VEGF-alpha and beta mRNA levels were also measured using methods such as qPCR and ELISA.


Results:

We could show that at lower concentrations and a 72 hour incubation period Artesunate killed HT-29-AK cells, and decreased E-Cadherin and VEGF-alpha and beta levels. Levels.


Conclusion:

The results allude to the cytotoxic effect of Artesunate and lower concentrations for 72 hour incubation periods and its effect on HT-29-AK cells with potential clinical applications.

Figure 1 shows the concentration of ART on the X-axis and the percentage of control growth on the Y axis, this graph is aimed to show the effect of ART on HT-29-AK cells over varying periods of time.

As the incubation time period increases the drug is becoming more cytotoxic, if the cells are incubated with the drug for longer, a lower concentration is required. The pharmacological index is 72hr>48hr>24hr, the IC50 is the concentration at which the cells need to be incubated to kill half the number of cells:

24hrs: incubating the cells over of 24 hours leads to an IC50 of 165µM, this alludes to the requirement for higher concentration over shorter incubation periods. The Concentration required is 100.39µM more than if the cells were incubated for 48hours and 150.56 µM more if the cells were incubated for 72 hours.

48hrs: incubating the cells over of 48 hours leads to an IC50 of 64.61µM, the concentration required to kill half the number of HT-29-AK cells is 100.39µM less if the cells were incubated for 48 hours instead of 24 hours, however the concentration required to kill half the number of cells is 50.17µM more than if the cells were incubated for 72 hours instead of 48 hours.

72hrs: incubating the cells over of 72 hours leads to an IC50 of 14.44µM, the concentration required to kill half the number of cells over 72 hours is 150.56µM less than incubation for 24hours, and 50.17µM less than incubation for 48 hours.

Figure A and B shows the relative E-cadherin mRNA levels at different ART concentration incubated at 24 hours(Left) and 72 hours(right).


Relative E-Cad mRNA levels at 24 hours

Control: The control showed a relative E-Cad mRNA level of 1, at a concentration of 82.53µM

The concentration at 82.53µM showed a relative E-cad mRNA level of approximately 1.1, this relative expression is 0.1 more than the controls relative expression, the relative expression of E-cad mRNA levels at 82.53µM was 0.9 less than the relative expression of E-Cad mRNA at 165.06µM and 1.8 less than the relative expression of E-cad mRNA at 330.12µM. The concentration at 165.06µM, showed a relative E-cad mRNA level of approximately 1.9, which was 0.8 more than the expression at 82.53µM and 1.0 less than the expression at 330.12 µM. the concentration at 330.12µM, showed a relative E-cad mRNA level of approximately 2.9, an increase of 1.8 is observed compared to the ART concentration of 82.53µM and an increase of 1.0 is observed compared to the ART concentration of 165.06µM.


Relative E-Cad mRNA levels at 72 hours

Control: The control showed a relative E-Cad mRNA level of 1, at a concentration of 82.53µM

The concentration at 7.22µM showed a relative E-cad mRNA level of approximately 0.4, this relative expression is 0.6 less than the controls relative expression, the relative expression of E-cad mRNA levels at 14.44µM equal to the relative expression of E-Cad mRNA at 7.22µM and 0.01 less than the relative expression of E-cad mRNA at 28.88µM. The concentration at 28.88µM, showed a relative E-cad mRNA level of approximately 0.41, which was 0.01 more than the expression at 7.22 µM and 14.44µM

Figure C shows the level of staining of adhesion molecules

At 24 hours the control showed the least amount of staining compared to the ART concentrations at 82.53µM, 165.06µM and 330.12µM. At a concentration of 82.53µM there is an increase in staining compared to the control but there is less staining compared to 165.06 and 330.12µM concentrations. At an ART concentration of 165.06 µM more staining is observed compared to the control and at 82.53 µM however less staining is observed compared to 330.12µM. At the final ART concentration 330.12 µM an increase in staining is observed compared to the control, 82.53µM, and 165.06µM.

At 72 hours the control showed the most amount of staining compared to the ART concentrations at 7.22µM, 14.44µM and 28.88µM. At a concentration of 7.22µM there is a decrease in staining compared to the control but there is more staining compared to 14.44µM and 28.88µM concentration. At an ART concentration of 14.44µM less staining is observed compared to the control and at 82.53µM however more staining is observed compared to 28.88µM. At the final ART concentration 28.88µM a decrease in staining is observed compared to the control, 7.22µM and 14.44µM.

Figure A and B show the relative VEGF-alpha and beta mRNA levels at different ART concentrations.

Control: The control concentration showed the same relative mRNA levels for both VEGF- alpha and beta which was a level of 1.

7.22µM: the relative VEGF- alpha concentration was approximately 0.62, and the VEGF- beta concentration was 0.39, this means that at a concentration of 7.22µM, 0.23 µM more of VEGF-alpha mRNA levels is expressed compared to VEGF-beta mRNA levels.

14.44µM: the relative VEGF- alpha concentration was approximately 0.64, and the VEGF- beta concentration was 0.35, this means that at a concentration of 14.44µM, 0.19 µM more of VEGF-alpha mRNA levels is expressed compared to VEGF-beta mRNA levels.

28.88µM: the relative VEGF- alpha concentration was approximately 0.61, and the VEGF- beta concentration was 0.05, this means that at a concentration of 28.88µM, 0.56 µM more of VEGF-alpha mRNA levels is expressed compared to VEGF-beta mRNA levels.

The control showed a relative survivin mRNA level of 2, an ART concentration of 7.22µM showed a mRNA survivin expression of approximately 4 which is 2 more than the control. At an ART concentration of 14.44 µM a relative mRNA expression of 13 is observed, an mRNA expression of 9 more than at 7.22 µM and 13 less than 28.88µM.

At an ART concentration of 28.88µM a relative mRNA Survivin expression of 26 is observed, this level of expression is 13 more than at 14.44µM and 22 more than at 7.22µM. these results show that Survivin which is an inhibitor of apoptosis is inhibited over a 72 hour incubation period and a concentration of 7.22µM.

The control showed a % cleaved caspase 3 level of 100, an ART concentration of 7.22µM relative to the control showed 300% cleaved caspase-3 level which is 200% more than the control. At an ART concentration of 14.44 µM a relative to the control 320% cleaved caspase-3 levels was observed, which is 20% more than at 7.22 µM and 5% less than 28.88µM. At an ART concentration of 28.88µM the percentage of cleaved caspase-3 relative to the control was 325%, this level of expression is 5% more than at 14.44µM and 25% more than at 7.22µM.


4. Discussion

Jiang W et al experimented with Artesunate on osteosarcoma cells, Artesunate was combined with another compound called allicin, which was derived mainly from garlic. The aim of this experiment was to investigate the synergistic effects of the combined therapy. The results of this experiment showed a decrease in concentration of osteosarcoma cells, a decrease in invasion, motility, and the colony formation of these cells, this occurred due to an increase in Caspase3/9 expression when combined. In Prof Olivera’s experiment the methods only included Artesunate and the cleaved caspase activity were all similar at different concentrations, the difference in methodology is apparent because two compounds was used in Jiang W et al’s study while only one was used in Prof Oliviera’s study.

Liu Y et al also used a combination therapy to investigate the cytotoxic effect, triptolide and Artesunate was used to inhibit the pancreatic cell line growth by inducing apoptosis, the experiment also showed a production of heat shock proteins which produce synergic effects. Similar to Prof Oliviera’s experiment Artesunate has a cytotoxic effect, however the similarity between these two experiments is that the combination therapy used in Liu Y et al and the single therapy used in Prof Oliviera’s study both were more effective in lower concentrations of Artesunate these allude to potential clinical applications.

Dong HY et al experimented the effects of Artesunate on breast cancer using tumour transplanted nude mice, cyclophosphamide or normal saline was used in combination with Artesunate and the results showed ART inhibiting the growth of the MCF-7 cancer cells by arresting the cell cycle.

In conclusion the findings of Prof Oliviera’s study is as follows:

  • Over a longer incubation period a lower concentration of Artesunate is required to kill half of the cancer cells.
  • Over 72 hours less Artesunate is reuired to reduce the relative mRNA levels. And less staining of adhesion molecules is observed over 72 hours as the concentration increases.
  • ART over 72 hours has a greater effect on decreasing the expression of VEGF-beta compared to VEGF-alpha.
  • Over 72 hours the higher the concentration of ART the increase in relative survivin mRNA levels.
  • The percentage of cleaved caspase-3 levels relative to the control increases as the concentration of ART increases.


References

  1. Dong HY et al, ‘Antitumour effects of Artesunate on human breast carcinoma MCF-7 cells and IGF-IR expression in nude mice xenografts’, 2014
  2. Liu Y et al, ‘Synergism of cytotoxicity effects of triptolide and Artesunate combination treatment in pancreatic cancer cell lines’, 2013
  3. Jiang W et al, ‘The synergistic anticancer effect of Artesunate combined with allicin in osteosarcoma cell line in vitro and in vivo’, 2013

Geoffrey Keynes Research on Cancer Treatment

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In God We Trust. All Others Must Have Data

Radical surgery had undergone an astonishing boom in the 1950s and 1960s. William Halsted had become the patron saint of cancer surgery in the United States. But at St. Bartholomew’s Hospital in London, a doctor named Geoffrey Keynes was not convinced.

In August 1924, Keynes examined a patient with breast cancer. Rather than reaching indiscriminately for a radical procedure, he opted for a much more conservative strategy. He buried fifty milligrams of radium in her breast to irradiate her tumor and monitored her to observe the effect. Surprisingly, he found a marked improvement. Her tumor had reduced so rapidly that Keynes might be able to remove it with a minor surgery.

Over the next five years, Keynes tried other variations of the same strategy. The most successful variation was to remove the tumors with a minor surgery, followed by a small dose of radiation to the breast. Nothing was radical, yet their cancer relapse rate was comparable to those got by using radical surgery in Baltimore and New York. In 1927, Keynes reviewed his experience combining local surgery with radiation in a technical report to his department. But his theory and operation were ignored by American surgeons. They called Keynes’s surgery “lumpectomy.”

In 1953, a colleague of Keynes’s gave a lecture on the history of breast cancer at the Cleveland Clinic in Ohio, focusing on Keynes’s observations on minimal surgery for the breast. In the audience was a young surgeon named George Barney Crile. Crile had learned the radical mastectomy from students of Halsted. But he was having his own doubts about radical mastectomy. As Crile poured through Keynes’s data, the flaw in the logic of radical surgery came to light. If the breast cancer was locally confined, then it could be cured by a small local surgery. Radical surgery could add no benefit. If the tumor had already spread outside the breast, then even the most exhaustive surgery would be useless.

Crile gave up on radical mastectomy and treated breast cancer using an approach similar to Keynes’s. Over six years, he found that the effect of his “simple mastectomy” was remarkably similar to Keynes’s, with patient survival rates similar to those got from radical mastectomy.

A Pennsylvania surgeon named Bernard Fisher had also lost faith in radical mastectomy. In 1971, Fisher organized a clinical trial through the NSABP – National Surgical Adjuvant Breast and Bowel Project – to test the efficacy of radical mastectomy against lumpectomy+radiation and simple mastectomy. It took Fisher 10 years to gather that data. 1,765 patients from 34 centers in the United States and Canada enrolled in the trial. Patients were randomized into three groups: one treated with simple mastectomy, the second with lumpectomy followed by radiation, and the third with radical Mastectomy. The results of the trial were made public in 1981. The rates of breast cancer relapse, death, and metastasis were statistically identical among all three groups.

Radical mastectomy is rarely, if ever, performed by surgeons today.

In 1973, a 22-year-old veterinary student in Indiana named John Cleland was diagnosed with metastatic testicular cancer-cancer of the testes. The cancer had metastasized into his lungs and lymph nodes. In 1973, the survival rate for such a cancer was less than 5 percent. Cleland was under the care of a young oncologist named Larry Einhorn in the cancer ward at Indiana University. Einhorn initially treated Cleland with a three-drug cocktail called ABO, which was found to be marginally effective. In the fall of 1974, Einhorn replaced the ABO regimen with a new chemical called cisplatin. Other researchers had seen transient responses in testicular cancer patients treated with cisplatin. Einhorn wanted to see if he could increase the response rate by combining cisplatin with two other drugs. For Celand, it was a choice between the uncertainty of the new regimen and the certainty of death. He took the gamble and enrolled as “patient zero” for BVP, the new regimen containing bleomycin, vinblastine, and cisplatin. Ten days later, the tumors in Cleland’s lungs had vanished.

By 1975, twenty additional patients had enrolled in the trial – all with remarkable and durable responses similar to Celand’s. By the late winter of 1976, it had become clear that some of these patients would not relapse at all.

***

Meanwhile, the NCI had turned into a factory of toxins. With money from the National Cancer Act, the institute’s drug-discovery program was testing zillions of chemicals each year to discover new cytotoxic drugs. The money also stimulated enormous, multi-site trials, turning academic centers into drug factories and cancer hospitals into efficient trial-running machines.

It was trial and error on a humongous scale, not targeted research. In one NCI-sponsored trial, known as the eight-in-one study, children with brain tumors were administered eight drugs in a day. Most of the children died soon afterward, having only marginally responded to the chemotherapy.

Professional development plan for the nurse educator Custom Essay

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Professional development plan for the nurse educator Custom Essay

Conclude with a summary of the key points in each part of your paper, including citations for supporting literature.
Include a minimum of 17–20 references, with at least 15 of your references coming from peer-reviewed sources.
Use correct APA style and formatting. Pay particular attention to citations and references. APA Refresher may be helpful to you. Include APA subheadings.
Include an appendix containing any additional tools or tables you may have found useful in your plan.
The paper should be created in Microsoft Word and be at least 10 pages in length, double-spaced, excluding cover page, table of contents, page numbers, running header, abstract, and references.
Use Times New Roman or Arial 12-point font.
Written communications should be free of errors that detract from the overall message.

Professional development in nursing education is a fundamental process that nurses use to identify, plan, and design a plan to meet professional goals. For this assignment, build upon some of your previous coursework by analyzing the role of the nurse educator and designing a plan for professional development for you as a nurse educator.

This assignment is divided into four parts:

Part 1 provides your overview of the nurse educator role with your evaluation of its impact on nursing and you as a nurse educator. It also includes your personal nursing teaching philosophy.
Part 2 is your summary and evaluation of key concepts and behaviors in education.
Part 3 is your summary and evaluation of practices and behaviors of the nurse educator role.
Part 4 provides a design and plan for your professional development as a nurse educator. This is the largest section of the paper.

Reflection about “Something the Lord Made”.

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Reflection about “Something the Lord Made”.

Subject: Nursing
I need a one full page reflection paper about the movie called “Something the Lord Made”. Basically you need to describe two nursing interventions appropriate to apply to the situations demonstrated in the film. You also need to reflect on your feelings about the film like if you were a nurse. Thank you.

Literature Review on Childhood Obesity and Treatment

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Obesity has become a huge problem within the Western World over recent years. (34% of the adult population in the US in 2007 (Barness (1986: 75)). It is known from the general media that the incidences of childhood obesity are also on the increase. This review aims to evaluate the ideas and concepts from two Journals. Barness, L.A. (2007) ‘Obesity in Children’. Ells et al, (2005) ‘Prevention of Childhood Obesity’.

Childhood Obesity

According to Barness (1986: 75-76), there are a number of tools used to define the obese child. weight for height is the most common used as it uses a chart and the skinfold thickness becomes very erroneous in the obese child due to errors in measurement. The BMI uses charts to which take into account the gender and age of the child which then encompasses more of the variables within children (not apparent in adults) resulting in increased accuracy. There is some debate as to causes of obesity. Some causes are thought to be (Ells et al. (2005: 443)) gender, race, socioeconomic status, special educational needs, environmental factors and genetics (although Ells et al. (2005: 442) states that ‘fewer than 1% of childhood obesity cases are directly caused by a genetic disorder’).

There are also a number of disease states causing secondary obesity which need to be ruled out prior to attributing the unexplained weight gain to the above causes. These include neurological lesions, endocrinopathies and congenital syndromes (Barness (1986: 82)). There are various factors affecting the obese child including psychological as Obese children often suffer from low self esteem and some can go on to develop depression (10% become clinically depressed Barness (1986: 77)) whereas others ‘comfort eat’ leading to obesity.

There are a number of risk factors which can result from an obese child which include hypertension, diabetes mellitus and dyslipidemia. (Chu et al. (1998: 1141) Dyslipidaemia includes hyperlipidaemia, elevated low-density lipoproteins, and decreased high density lipoproteins (Barness (1986: 81)).

Sleep apnoea a common cause of pulmonary insufficiency Barness (1986: 77). The child can wake up many times a night resulting in constant sleep deprivation. This can be life limiting as it puts a strain on the heart also. It has been reported that some children can benefit from tonsillectomy and adenoidectomy Barness (1986: 77). However, Zafer et al. (1999: 33) have concluded that this treatment is associated with an increase in weight, height and BMI.

Obesity Treatment

As the causes of obesity are varied, so the treatment also needs to be varied. As well as dealing with the causes of obesity there maybe other health issues to be dealt with also. (see above) . The major treatment options involve diet, exercise and behaviour modification (Barness (1986: 83). The dietary requirements need to be under strict medical supervisions as the child is still growing and requires essential nutrients for growth. Barness (1986: 83) states that a protein-sparing modified fast (PSMF) diet has been used and appears safe and can stimulate the respiratory system and blunt the appetite due to ketones being released as the diet is also low in carbohydrates. Barnes does not, however, go into details of behaviour modification or exercise programmes.

Obesity Prevention

There a number of factors which cause obesity, as stated above. A holistic approach is required to ensure obesity does not occur in the child. According to Ells et al. (2005: 441) evidence supports measures which ensure physical activity and a healthy diet as well as adequate behavioural support for the child to reduce the risk of obesity. Interventions which will aid children to live and grow healthily can come from a number of different sources.

School Intervention

Schools can influence a child’s behaviour and therefore help in the health prevention of obesity. Ells et al. (2005: 444) that a review highlighted a number of health prevention programmes. One of these was based on children being taught via a national curriculum to reduce their sedendatory behaviour. This showed a reduction in obesity. Another two were based on physical activity programmes which showed that there was no significant reduction in obesity over a control group. The multi-faceted approach of nutrition, education, behavioural therapy and physical activity showed that this may help to reduce obesity, especially in girls. Ells et al. (2005: 444) concluded that much more research is needed in this area. Research carried out by Nauta, Byrne and Wesley (2009: 16-17) concluded that school nurses had an awareness of childhood obesity but were unable to set up treatment programmes.

Family Intervention

There are a number of different behavioural causes within the family environment, including the mother’s knowledge of nutrition and opportunities to share family meals. Ells et al. (2005: 445 – 446) also cited studies undertaken to examine the efficiency of family – based behaviour modification programmes and health promotion which did not support any significant decrease in weight in the obese child. Goodfellow and Northstone (2008: 117) found out that children from the Isle of Man were more likely to be obese than in Avon, showing that external influences will have a bearing on the family and individual’s health.

Preschool / Anti-Natal Intervention

A significant number of children are obese at pre-school age. However there is little evidence to support the need for intervention within the pre-school age chilidren. Ells et al. (2005: 446 – 447) questions whether obesity prevention should begin during the ante-natal period and cited a study finding maternal weight to correlate to preschool obesity but another found that breast feeding had a protective effect on childhood obesity. A study by Rossem et al. (2010: 7) supports the link between breast feeding and reduced obesity in the child. Morgan (1986: 34)) cited that expectant parents should be alerted to the dangers of childhood obesity as there is a strong link with a parent and child’s body weight.

Government Policies

Ells et al. (2005: 449) indicates that in order to prevent the growing trend of obesity Governments must have a key role. For instance Ells et al. (2005: 449) a number of UK police documents including the Health Select Committee Report on Obesity (2004).

Monitoring To Ensure Prevention is Working

It is vital that preventative measures in place are monitored to ensure that they are reducing both the incidence and severity of childhood obesity so that resources can go to the appropriate measures.

Ells et al. (2005: 449) stated that monitoring in most countries consists of only occasional surveys. The UK Essential Core Database for child health have recommended that monitoring (BMI) be carried out on children at entry and exit from both primary and secondary schools. Research carried out by Levine et al. (2008: 255), however, showed that monitoring of primary school children was achievable but that of secondary schools was not.

Conclusion

It can be concluded that childhood obesity is a large, increasing problem within the western world which will follow on into adulthood. This essay has aimed to give an overview of the theories and evidence surrounding childhood obesity including associated diseases, treatments, preventative measures and people involved in supporting the obese child as well as those factors thought to cause the obesity in the first place. This is a complex issue with evidence currently emerging.

This review was mainly focussing on the use of two articles Obesity in Childhood and Prevention of Childhood Obesity which between then cover all the issues surrounding childhood obesity. Where there is further supporting or refuting evidence I have added this. The literature included here is by no means comprehensive and the reader may wish to research an aspect of childhood obesity in greater depth.

This student written literature review is published as an example. See

How to Write a Literature Review

on our sister site UKDiss.com for a writing guide.

Has the patient been informed of benefits and risks, understood this information, and given consent?

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Has the patient been informed of benefits and risks, understood this information, and given consent?

Let’s have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion.

The diversity movement suggests that there is strength in our differences and that our differences enhance each other. At the same time, the movement insists that our differences should not have economic, social, or political consequences. We are entitled to the same access to resources and opportunities regardless of our differences. The human suffering from Hurricane Katrina and the images of victims has stimulated the debate about differential access to resources.
Read the report Women in the Wake of the Storm: Examining the Post-Katrina Realities of the Women of New Orleans and the Gulf Coast. On the basis of your reading, create a report, answering the following:
• Discuss the prominent dimensions of diversity revealed as a result of the Hurricane Katrina disaster.
• Discuss factors that specifically influenced women’s vulnerability to Hurricane Katrina. While answering, consider the primary dimensions mentioned in the lectures as well as the secondary dimensions such as parental and marital status, income, educational level, military experience, geographic location, work background, and religious beliefs.
• Describe the implications for healthcare organizations as a result of the disaster.
• Discuss at least of two of the policy implications that are outlined in the report. If you were given the task to add another policy recommendation what would it be and why?

Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

A Grumpy Old Man – Case Study

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What are the possible diagnosis for the patient?

Evaluate a health care policy issue through the lens of Kingdon’s theory and provide evidence-based references to support the evaluation

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 Lens of Kingdon’s theory

Identify a policy gap relating to a clinical issue or concern. Identify a solution for addressing the gap.

Describe a plan for how you will implement the solution.

Address an element of the proposed intervention and demonstrate your role as an advocate (—presentation).

In addition, address the following in your paper:

Describe the elements of Kingdon’s Agenda-setting theory that were operating in your project.

Review Howie’s 2002 article, “Mandatory Reporting of Medical Errors: Crafting Policy and Integrating It Into Practice,” from study, if you need a refresher on the elements of Kingdon’s theory.

Format your final paper with completed reference list (and appendices if needed).

Resources: Mandatory Reporting of Medical Errors: Crafting Policy and Integrating It Into Practice.

Grading Rubric Critically analyze health policy proposals, health policies, and related issues from health care stakeholder perspectives.

: Provides a comprehensive evaluation of health policy proposals, health policies, and related issues from health care stakeholder perspectives and provides evidence-based references that support the evaluation.

Advocate to improve health care delivery and outcomes.

: Advocates to improve health care delivery and outcomes across a wide range of stakeholders. Advocate for the nursing profession in the policy and health care communities.

: Advocates for the nursing profession in the policy and health care communities and identifies avenues for nurses to participate in the policy reform process. Advocate for social justice, equity, and ethical policies within all health care settings.

: Advocates for social justice, equity, and ethical policies within all health care settings and identifies a variety of avenues for nurses to act as advocates. Evaluate an intervention strategy in terms of both process and outcomes.

: Provides a detailed evaluation of an intervention in terms of both process and outcomes and provides new evidence-based options for overcoming any challenges in the stated intervention strategy.

Describe a health care policy issue through the lens of Kingdon’s theory.

: Evaluate a health care policy issue through the lens of Kingdon’s theory and provide evidence-based references to support the evaluation. Communicate in a manner that is consistent with the expectations of a nursing professional.

: Demonstrates exemplary writing skills, including adept integration of research into written documents that follow APA format without errors; error-free use of grammar, punctuation, and mechanics as expected of a nursing professional; and effective use of peer-reviewed and evidence-based references.

Written communication: Written communication is free of errors that detract from the overall message. APA formatting

Psychosocial Concepts in Radiography

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“Promising too much can be as cruel as caring too little” (Kelley, 2005, p. 69). The aim of this assignment is to describe and discuss the psychosocial aspects of patient/client care as applied to radiography, and the skills required the deal with a range of issues in work environment and explore medico legal aspects of radiographer’s scope of practice while relating to the given scenario.

Oxford English Dictionary(2013) defines psychosocial as “relating to the interrelation of social factors and individual thought and behaviour” and medico legal “refers to that which is related to medicine and the law. It refers to that which pertains to the legal aspects involved in the practice of medicine. It covers the prerogatives and responsibilities that a medical professional is bound by as well as the rights of the patient” (AJ, 2013).

Upon arriving to the department it is paramount the radiographer justifies the x-ray request form on clinical grounds, and must adhere to the minimum requirements set by IR(ME)R which requires 3 forms of ID, the request form to be signed, information to identify the patient and clinical information to justify exposure. (DoH, 2000). once patient has been located, the radiographer is greeted by angry relatives who are complaining their mother had nothing to drink for 24 hours and has soiled herself, with this in consideration it is vital the radiographer introduces themselves and confirms the patients details for example, patients name, DOB and Address and hospital number if checking wristband as patient has limited ability to communicate. Infection control will be required as the patient has defecated herself, a quick check for infections such as clostridium difficile; if infections are present it should be present on the x-ray request or patient notes.

The first impression a patient forms from the way practitioner portray themselves by greeting the patient and explaining the procedure in the first few minutes. If a negative impression is formed during this encounter, it will be difficult to erase and the subsequent practitioner and patient interaction will be affected (Ramlaul and Vosper, 2013). When dealing with the patient/relatives the radiographer must be assertive, confident compassionate, and empathetic to the patient’s situation (Scriven and Orme, 2001), and must use clinical reasoning which refers to thinking and processes associated with the clinical practice of health care providers (Higgs, Jones, Loftus and Christensen, 2008)

Reassure the family that you have just arrived and here to resolve the matter, explain there could be a valid reason regarding the water, but you will look into it. Give reasons why there might be a shortage of nurses due to “fast interaction period of emergency departments which may be similar times to medical imaging” (Ramlaul and Vosper, 2013, p.13). This might be why the radiographer was not able to locate the nurses. Communication between healthcare professionals and patients is paramount to improve quality of care for patients, and eliminate any possibility for mistakes (O’Daniel and Rosenstein 2008). This scenario has clearly demonstrated the lack of Inter-professional communication and collaboration and how detrimental it is to patient care.

The psychosocial aspects of any individual can be affected by a small initial stimulus which can start a chain of events that have enormous outcomes; this is known as the butterfly effect (Burton, 2013). Little do we realise a smile can be enough to put someone at ease, and that can be the difference between a positive experience and a negative one. We have to understand the social/environmental aspect of an individual also plays a huge role in the way they think, talk, and behave (Niven, 2000).

The radiographer must take into consideration the psychological state of the patient, which may help understand the different feelings the patient might be experiencing such as, anxiety, shame, angry, distressed, shocked, and unwell. It is important the radiographer focus on their thoughts and feelings to better treat them.

Compassionate care must be 1

st

priority for all health professionals; this constitutes the six C’s, Care, compassion, competence, communication, courage, commitment. This guide helps health professionals to make sure their care meets the standards patients rightly expect and deserve (Cummings and Bennett, 2012). This should apply to all health professionals. With regards to Francis report UK The Mid Staffordshire NHS Foundation Trust Public Inquiry, (2010) which was carried out from January 2005 to March 2009 for the hundreds of appalling failings of compassionate care were left in excrement in soiled bed clothes for lengthy periods and many other failings. Referring back to the scenario it is seen the patient is in a similar situation and as a witness; the radiographer must report this, failure to do so is against the law.

Radiographers should uphold National Health Service constitution and values which are based on comprehensive service available to all race, gender, disability, age, sexual orientation, religion or belief and adhere the core value of NHS, respect and dignity, commitment to quality of care, compassion, communication, improving lives, and working together for patients (DoH, 2013).

Communication comes in many forms, verbal, non-verbal (sign language, facial expression and other forms of body language) it can be difficult at times to assess patients, this may be due to may barriers such as gender, age, language and disability, each barrier differ from patient to patient, with regards to the scenario the frail old lady is in a venerable state and unable to communicate regardless the radiographer must communicate with her as she may understand other means of communication which may include simple muscle movements such as blinking or squeezing a hand. Due to the lack of time usually available to radiographers, the task of identifying and treating symptoms may become the only goal for the practitioner, who then denies the patient the opportunity to explain their illness (Edelmann, 2000).

Radiographers must provide holistic care for the patient, while assessing patients and their clinical requirements to determine appropriate radiographic technique, and to perform a wide range of radiographic examinations on patients to produce high quality images while observing and maintaining contact with patients during their waiting, examination and post-examination stay in the hospital, And complying with Data Protection Act, IRMER, IRR, ALARP, Health and Safety at work, and many more (Agcas, 2012). Radiographers must keep within their scope of practice based on competency, education, extent of experience and knowledge while practising in a safe and competent manner (SoR, 2008).

And adhere to legislations set for radiographers, scope of practice, local rules, policies and procedures and HCPC standards of proficiency, is responsible and accountable for the patient undergoing x-ray (and other imaging modalities).

What is scope of practice for a radiographer? HCPC (2012) defines the scope of practice is the area/areas in which the radiographer has knowledge, skills and experience to practice lawfully, safely and effectively in a way that meets the HCPC standards and does not pose a danger to the public or to yourself. However if a practitioner wanted to move outside their scope of practice can do so providing they are capable of working lawfully, safely and effectively.

Relating back to the scenario it may need to be considered whether taking a portable abdominal x-ray is in the local rules, policies, and procedures, must weigh the risks/benefit, consider their personal experience and is it enough to carry out the x-ray in a safe, effective and lawful manor. As health professionals one must understand their own capacity and limitations and act accordingly.

Taking consent from the patient can be verbal, written or implied. Every adult has the right to determine what is done to their body (UIC, 2004). Taking an x-ray without obtaining valid consent can be detrimental which leaves the practitioner open to lawsuits and questions their fitness to practice. As we know the patient is not able to communicate, hence the radiographer might adopt different means on consent for example implied. Patient might be asked to blink twice if it’s okay to go ahead and blink once if not vice versa. Pertaining to moving and handling patient the radiographer should make use of the mandatory manual handling training provided by the trust/university. The radiographer must not in under any circumstance cannot pat-slide by themselves and must have a minimum of 3 trained personals.

This scenario is a classic example of negligence, where no nurses are present to attend to the patient, torts law comes into play in this scenario, where unintentional negligence of the patient where the duty of care is at breech. If the radiographer carried out the x-ray after the patient had been cleaned by the radiographer and/or nurse, the radiographer must inform patient about the x-ray being taken and once consented markers must be used in the primary beams instead of post processing to avoid confusions, and most importantly, the x-ray can be used in court if required, furthermore upon taking the x-ray a holders form need to be filled in if holder was required and must wear lead coats. A risk assessment must be carried out to determine if it is possible to carry out the x-ray and apply ALARA (as low as reasonably achievable) as mobile x-rays tend to used higher exposures this is achieved by many ways such as increasing the FDD.

This scenario can most certainly make everyone feel agitated, stressed, scared and terrified, and nervous. However as professionals one must show confidence in the face of adversity and demonstrate good communication skills and follow the HCPC standards of conduct, the scope of practice, upholding the NHS constitution along with compassionate care guide, will ultimately enable the health practitioner to be more confident and well equipped in practice.

In conclusion one can argue it requires inter-professional team effort to give the best experience to any patient, which is be true, but it requires the efforts of each individual put together collectively to formulate productivity and efficiency for the best interests of the patients.

Reference List

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Population Health and Diabetes: A Public Health Concern

/in /by


Abstract

The aim of this paper is to discuss the definition of population health and healthcare systems approaches to improve the quality of care for patients with diabetes. To date, value-based care is an emerging solution for people to get the appropriate care needed at an affordable rate. Integrated delivery systems as such as patient-centered medical homes and accountable care organizations are at the forefront of managing chronic diseases. The intent of all of these programs is to pay for quality and ensure coordination of care.  There are risk stratification tools and care coordination tools that help the Care Management Team coordinate care and intervene for higher risk patients. There are also patient engagement tools that can be leveraged such as the Patient Health Records, chatbots, and campaign tools.  In addition, to improve the health of populations utilization of decision support tools, physician feedback, primary care teams with health professionals from various disciplines, electronic health records and disease registries are all used identify patients that are at risk. There is a chance for healthcare experts, public health specialists, and policymakers to collaborate in efforts to improve diabetes care.


Introduction

The term population health was introduced in 2003 by David Kindig and Greg Stoddart they defined it as “the health outcome of a group of individuals, including the distribution of such outcomes within the group” (“What is Population Health? | Population Health Training in Place Program (PH-TIPP) | CDC”, 2018). Population health is a field of study that focuses on the health status and healthcare utilization of a defined group of people. The main goal is to improve health outcomes of an entire group while reducing health disparities and inequalities. One might consider people with diabetes, people with diabetes are often included in health programs and are a focus of many population health initiatives. To date, population health programs have been set up by health care facilities, and insurers to reduce costs and effectively manage the chronic disease of diabetes (Ryan, 2018).

Within the United States, diabetes is one of the leading causes of death. To successfully prevent complications that may develop over time persistent medical management and patient self-management is required. To ensure patients are receiving the best care new care delivery and payment models are being implemented. In fact, there has been a lack of care for the total care of patients, to include the outcomes of their treatment and the effectiveness with which health resources are used.

Primarily health care services are paid on a fee for services basis which has contributed to the lack of care from health care providers. An emerging solution as such as value-based care is reducing health care costs, clinical inefficiency and duplication of services. This is making it easier for patients to get the appropriate care they need. The federal government is continuously implementing various payment models to achieve the best health outcomes at an affordable cost, in addition to commercial insurers are partnering with health care providers that also seek to reward value rather than volume of services. The Patient-Centered Medical Home and the Accountable Care Organization are two popular models of delivery system reform.  Providers must be able to forecast when a patient is most likely to become a high-risk patient. With the assistance of data analytics which is an integral part of population health management, the quality of care and a patient’s health can be effectively monitored. The gathered data can then be sent to payers and other outside entities.   Care management aims to manage the overall health of a population of high risked patients. Another goal is to ensure a patient receives care at the right time, and place.   In addition, care managers utilize care management systems to facilitate transitions of care by using automated systems to effectively manage high-risk patients.   For example, the risk of progression from glucose intolerance to diabetes mellitus can be influenced by diet and exercise. Individuals within this “rising risk” population are at different stages of readiness to change and consequently at different stages of modifiable risk. Having this insight enables providers to offer services at the appropriate level and time (AHRQ, 2015)


Population Health Programs: Value-Based Payment Programs

Within the United States, it is accounted that diabetes is one of the United States rapidly growing economic burdens.  Currently, diabetes is at a $245 billion annual cost. The cost is solely related to how well the disease is managed. Diabetes is often poorly managed and treatment is complex because it requires drug therapy and behavioral modifications. Consistent poor diabetes management typically results in additional complications. Those additional complications lead to increased inpatient stays, outpatient visits, and additional medical costs.  To reduce high costs, insurance providers have begun to penetrate the health care market with new risk-adjusted incentive payment models. They require physicians to meet and report quality measures for patients with chronic diseases, including diabetes.    The payment requirement has penetrated accountable care organizations that are comprised of primary care entities and individual providers (Hodorowicz, 2016).

Accountable Care Organizations consists of groups of doctors, hospitals and other health care providers that voluntarily come together to provide quality care to patients. They provide coordinated help and care to patients with a chronic illness. Their goal is to ensure that the right care at the right time is provided to avoid duplication in services and prevent medical errors. Accountable Care Organizations aren’t solely just responsible for the quality of care that a patient receives but the overall cost of the care the patient receives. To ensure that Accountable Care Organizations remain in compliance they are supervised by government agencies to ensure that the treatment plans are being properly coordinated and high quality of care is being provided. In addition, Accountable Care Organizations are required to file governmental documentation showing how much money they were able to save the Medicare system. Accountable Care Organizations receive incentives of shared savings bonuses equal to a percentage of the money they saved (“Accountable Care Organizations (ACOs) – Centers for Medicare & Medicaid Services”, 2018).

When mentioning Accountable Care Organizations one might consider the Medicare Shared Savings Program.  The Medicare Shared Savings Program is a payment model whereas healthcare providers and hospitals receive an incentive for achieving better health. This in terms also leads to better population health and lowers healthcare costs. In order for a health care provider to be a part of the Medicare Shared Savings Program, the provider must be a part of the Accountable Care Organization. The Medicare Shared Savings Program requires Accountable Care Organizations to promote evidence-based medicine, engage beneficiaries, report internally on quality and cost metrics, and provide coordinated care across and among primary care physicians, specialists, and acute and post-acute providers. To date, The Medicare Shared Savings Program is quickly growing and being adopted by healthcare providers because of the awareness of the revenue-generating opportunities in Accountable Care Organizations as well as avoidance of penalties under the Merit-based Incentive Payment System (“What is the Medicare Shared Savings Program (MSSP)? | Continuum”, n.d.). Other Accountable Care Organization models would The Next Generation Model offers financial arrangements closely related to the Medicare Shared Savings Program but with the difference of higher levels of risk and rewards. In addition, the Next Generation Model offers telehealth, 3-day skilled nursing facility, post-discharge home visit waivers with the option to participate in populated based payments. (“ACO’S & the Medicare Shared Savings Program (MSSP): How They Strategize Together Towards Value”, n.d.).

Accountable Care Organizations do not only focus on an individual’s health but also seek to improve the health of the entire population for whom they are accountable for.  This is better known as population health management. To date, many physicians haven’t adopted prevention-oriented population health in their current model of healthcare delivery. Most physicians have only treated patients with acute problems. The physician is then consumed with managing the patient’s acute problem rather than addressing preventive chronic care needs.

Accountable Care Organizations are utilizing risk stratifications for better population health management. Risk stratification is the process of assigning a risk status to a patient and using the obtained health information to provide direct care and improve the patients’ overall health. Risk stratification is practiced by top performing population health-focused organizations. A patient’s assigned risk category is determined at the first point of contact. The patients are separated into the categories of high, medium and low-risk groups. To further assist with the categorizing of patients, the following outline is being used by healthcare facilities: STEP 1 Compile a list of health center patients STEP 2 Sort patients by condition STEP 3 Stratify patients to segment the population into target groups based on the number of conditions per patient STEP 4 Design care models and target interventions for each risk group (“Value Transformation Framework Action Guide”, 2017).


Risk Scores: Hierarchical Condition Categories

Hierarchical Condition Categories were created in 1997 by the Centers for Medicare and Medicaid Services. Hierarchical Condition Categories are risk adjustment models that utilize patients diagnoses and demographic information to foresee medical costs.   The Hierarchical Condition Category coding identifies patients that have been diagnosed with a chronic health issue. The diagnoses are classified using the International Classification of Diseases-10. The International Classification of Diseases-10 is matched with the 79 Hierarchical Condition Category codes kept in the Centers for Medicare and Medicaid Services risk adjustment model. In addition to the coding for the diagnoses, other factors as such as age, and gender are also used to give members a risk factor score, the score is used to help determine Medicare reimbursements. Recently, the Centers for Medicare and Medicaid Services began scoring physicians and practices on their performance in the four areas of quality, cost, improvement activities and advancing care information (“Understanding Hierarchical Condition Categories (HCC)”, 2018).

To keep communities healthy, it requires assessing, monitoring and prioritizing risk factors that impact health outcomes. Public health has the ability to control its proficiency in population health metrics to help Accountable Care Organizations understand the epidemiology of patient population. Accountable Care Organizations managing high-risk patients leads to the lowering of Medicare spending, more effective management and optimized use of health care services, improved care management and preventative screenings for chronic illnesses. Understanding what works and what does not is key to ensuring reimbursements, controlling costs and most importantly, providing the best care for patients (Glaser, 2012).


Use of Technology and Analytics

To date, health care facilities are implementing strategies to bring awareness to patients that have a chronic disease, specifically diabetes.  Healthcare facilities are educating patients about their condition and including them in treatment decisions. Eating healthy and physical activities are of importance when it comes to managing diabetes. To remain productive, diabetes self-management skills and behavior change are essential to effectively gaining glycemic control. Self-management would include glucose monitoring, healthy eating, and daily physical activities.  In addition, physicians are assigning patients wellness coaches and conducting motivational interviewing to lead to behavioral changes in diet and exercise and increased self-management. Physicians conducting the motivational interviews encourage patients to reach their health goals. This is done by reviewing the patients previous and current A1C levels and other health records. Once the A1C level is reviewed the physician helps the patient set a goal to meet and monitor their progress.  Other organizations are utilizing motivational interviewing to inform patients about diabetic medications, ways to get reminders to fill their prescriptions and given detailed information about taking the medication properly.  This is an indication that electronic health records are a useful tool in managing patient care. The care team is able to quickly identify tests and routine preventive care that is needed. Studies have shown that patients are becoming eager to use technology for disease management. Telehealth is also being used to capture and monitor data from patients at home. Examples include monitoring patient blood sugar levels through glucometers attached to cell phones.  There are various apps designed for those with diabetes and physicians that treat diabetes. Many patients are using connected health. Connected health is a technology-enabled, integrated care delivery that allows for remote communication, diagnosis, treatment, and monitoring. Its goal is to provide improve digital connectivity between providers and patients to allow individuals to access the care they need anytime and anywhere (Copeland, 2018). Another benefit to the Connected Health patients will l diabetes will be to track their numbers, manage risk factors and utilize the reminder feature. However, before the Connected Health can be fully adopted the barrier of payment has hindered its full acceptance. This is because physicians that are still within the fee for service model are unable to bill the patient unless the patient visits the office, which means taking full advantage of telehealth may be a challenge. Physicians are also utilizing social media to assist patients with effectively managing their diabetes. Social media sites as such as Facebook, Twitter, and YouTube allow providers to communicate with patients and share information about new clinical offerings, links to self-management tools and invitations to chronic care management programs. Also, automated messaging tools are utilized to help patients schedule necessary appointments, fill prescriptions and comply with discharge orders. This is done via texted-mail or phone.



Conclusion

In conclusion, Accountable Care Organizations must continuously take steps to work collaboratively with public health agencies, communities and healthcare organizations to improve the health of the population.  As the health care industry transitions, physicians must consider what new relationships, processes, and information technology assets and skills will be needed to succeed.  Most importantly, the success of Accountable Care Organizations will stem from health care providers engaging patients in managing their care and overall health.



References