Consider the following data for a clinical laboratory Activity Show more Consider the following data for a clinical laboratory

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Consider the following data for a clinical laboratory Activity Show more Consider the following data for a clinical laboratory

Activity cost driver test a test b test c test d Recieve specimen $ 10 000 number of test 2000 1500 1000 500 Equipment set up 25000 number of minutes per test 5 5 10 10 run test 100000 number of minutes per test 1 5 10 20 record results 10000 number of minutes per test 2 2 2 4 transmit results 5000 number of minutes per test 3 3 3 3 total costs 150000 A. Using the ABC METHOD determine all allocation rate for each activity b. using the allocation rate estimate the total cost of perfeorming each test c. verify the total anual cost from individuls test costs equal the annual costs of the laboratory. Show less

Transcultural Nursing

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Transcultural Nursing

Posted on 7th October 2015 by Mike G in essay

Transcultural NursingOrder Descriptionoutline and define the term transcultural nursing , its history and relevance in modern nursing practice. Particular attention must be paid to its use in the Australian context. How can you apply this to your nursing practice.In text apa style referencing , 4 references required , must not be older than 10 years and apa style in reference list.

Treatment of Severe Idiopathic Mixed Autoimmune Hemolytic Anemia

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SUCCESSFUL


TREATMENT OF SEVERE IDIOPATHIC MIXED AUTOIMMUNE HEMOLYTIC ANEMIA


WITH BORTEZOMIB AND INTRAVENOUS IMMUNOGLOBULIN


ABSTRACT


Introduction

Autoimmune hemolytic anemia (AIHA) is a rare and diverse group of acquired hemolytic anemias which results from increased destruction of red blood cells (RBC) due to autoantibodies directed against antigens on the RBC surface. Currently, there are no clearly defined evidence-based guidelines on the management of AIHA and current treatment options are based on small retrospective studies, case reports as well as expert experiences and recommendations. We report a case of severe idiopathic mixed AIHA that responded to a combination of steroids, intravenous immunoglobulin (IVIG) and bortezomib.


Case Presentation

A 25-year-old African American female presented with jaundice, shortness of breath and abdominal pain. She had splenomegaly on examination and labs were significant for severe anemia (hemoglobin, 3.3) and hyperbilirubinemia (total bilirubin, 26.7; direct bilirubin, 21.9). Direct antiglobulin test (DAT) was microscopically positive for anti-IgG and anti-C3d, and cold autoantibodies were identified. An extensive workup for a possible secondary cause of her anemia was non-revealing. She was sequentially treated with prednisone, IVIG and bortezomib. Tremendous resolution of the hemolysis was achieved with improvement in the hemoglobin from a nadir of 3.2 on admission to 10.1 at discharge. Patient has remained clinically in remission since then.


Conclusion

The first line treatment for warm AIHA (w-AIHA) includes glucocorticoids and transfusion of least incompatible RBCs. But steroids are rarely necessary or effective in cold agglutinin AIHA in which case high dose IVIG and plasmapheresis have been used albeit with inconsistent results. Bortezomib is an inhibitor of the 26S proteasome and is approved for the treatment of multiple myeloma. It has been reported to have some activity in rituximab-resistant cold agglutinin disease (CAD) due to its activity against the CD20-negative plasma cell compartment that may be responsible for IgG anti-RBC autoantibody production.


Introduction

Autoimmune hemolytic anemia (AIHA) results from increased RBC destruction caused by autoantibodies reacting against RBC antigens with or without complement activation

1

. The clinical presentation depends on the subclass type (warm agglutinin, cold agglutinin, and mixed type); a classification based on the thermal amplitude of the causative autoantibody. Mixed AIHA is an unusual and rarely reported type of AIHA in which the laboratory data satisfy the serologic criteria of both w-AIHA and CAD

1

. The rarity of this form of AIHA presents a therapeutic challenge as the class and characteristics of the causative autoantibody play a role in the patient’s treatment and outcome

2

. Equally imperative to treatment outcomes is the need to determine the etiology of AIHA as over 50% of cases are secondary to a number of infectious, neoplastic and autoimmune disorders

3

where a resolution of symptoms can be achieved with the treatment of the underlying etiology. Therapeutic options for the treatment of hemolysis associated with mixed AIHA are limited

4

as it is associated with a more severe disease course. Herein, we present the case of a patient in whom resolution of hemolysis and improvement in hemoglobin count was achieved following sequential treatment with steroids, IVIG and bortezomib.


Case Description

A 25-year-old female visiting from Out-of-State presented to the Emergency Department (ED) with abdominal pain, shortness of breath, vomiting and subjective fevers. She had previously been investigated for abdominal pain about 7 months prior to current presentation. At that time, she was informed of some problems with her liver and asked to return to the clinic but was lost to follow-up. The patient did not have any other significant past medical history and was not taking any regular medications.

Her vital signs were stable except for sinus tachycardia of 143 beats/min. Physical examination revealed pallor, deep jaundice, and mild splenomegaly. Laboratory findings included anemia (hemoglobin 3.3 g/dl and hematocrit 10.2), elevated bilirubin (total bilirubin 26.7 and direct bilirubin 21.9) and elevated lactate dehydrogenase (LDH) of 193 U/l. White cell and platelet counts were normal. Direct Coombs test (anti-IgG and anti-C3) was positive and cold-reactive autoantibodies were identified and the titer was reported as high but not given in the report. Computed tomography (CT) scan of the abdomen showed splenomegaly.

Infectious mononucleosis, cytomegalovirus, parvovirus, syphilis, mycoplasma pneumonia, systemic lupus erythematosus, and human immunodeficiency virus were all ruled out. Blood, urine and sputum cultures were negative. Antinuclear antibody (ANA) immunofluorescence assay was initially positive but subsequent ANA screen was negative. This was attributed to the intravenous immunoglobulin she received. Screening for Wilson’s disease and hemochromatosis were also negative.  Subsequently, fine needle aspiration biopsy of an axillary lymph node was performed and this revealed benign lymphoid cells. Flow cytometry for leukemia/lymphoma panel detected no clonal B-cell or atypical T-cell population.

Due to the antibody load in her blood, the blood bank sent her sample to the Red Cross Reference laboratory to find the least incompatible blood for her. She was transfused several units during her hospital course. The Hematology service was consulted and a diagnosis of mixed type autoimmune hemolytic anemia was made. Thus, the patient was given a loading dose of intravenous methylprednisolone 125 mg once, followed by oral prednisone 100 mg daily. Simultaneously, she was started on intravenous immune globulin 100 g daily for 2 doses. In spite of the above therapy, the patient’s hemoglobin and clinical status did not improve substantially and she continued to require almost daily blood transfusions. Based on anecdotal isolated reports of the efficacy of bortezomib in autoimmune hemolytic anemia, our patient was started on bortezomib 2.7 mg every 72 hours and got a total of 4 doses. Following the first two courses of bortezomib, the patient showed a remarkable clinical improvement. Her hemoglobin levels started trending up and she no longer required blood transfusions. Markers of acute hemolysis like lactate dehydrogenase, bilirubin levels, and reticulocyte count also dropped progressively. Subsequently, the prednisone was gradually tapered.  At discharge, her hemoglobin was 10.1 (figure 1), total bilirubin 5.2 (figure 2) and direct bilirubin 2.3. A follow-up call to her Hematologist at the facility where she follows up in her home state 1-month post discharge confirmed that she has remained in remission and hemoglobin levels have remained stable.

Figure 1 showing the trend of hemoglobin from admission to discharge.

Figure 2 showing the decline in total bilirubin following the initiation of treatment.

 


Discussion

Diagnosis of mixed AIHA is based on the detection of autoantibodies by monospecific direct antiglobulin test (DAT) showing a pattern of IgG, complement C3d and presence of cold agglutinins

5

which are mostly of the IgM class. It is a rare diagnosis, comprising < 5% of reported cases of AIHA. Based on our patient’s clinical presentation, laboratory analysis and absence of an obvious secondary etiology after an extensive workup, she meets the criteria for idiopathic or primary mixed autoimmune hemolytic anemia.

The standard therapeutic approaches to the treatment of autoimmune hemolytic anemia include corticosteroids, splenectomy, immunosuppressive agents and monoclonal antibodies

3

, the most reported of which is rituximab. Rituximab is a potent anti-CD20 monoclonal antibody that destroys B lymphocytes via complement activation and has been used in the management of patients with cold agglutinin disease with severe hemolysis that has not responded to conventional therapy. However, the effect of treatment with rituximab is unpredictable and is usually not abrupt

2

. Khandelwal et al hypothesized that autoimmune cytopenias become refractory because current therapies do not target autoreactive plasma cells, and outcomes can be improved with plasma cell agents

6

such as bortezomib.

Bortezomib is an inhibitor of the 26S proteasome, a large protease complex that degrades ubiquitinated proteins and is approved for the treatment of multiple myeloma and mantle cell lymphoma in the United States

7

. By blocking the targeted proteolysis usually performed by the proteasome, bortezomib disrupts various cell signaling pathways, leading to cell cycle arrest, apoptosis, and inhibition of angiogenesis. In contrast to rituximab, which targets CD20 B lymphocytes, bortezomib targets differentiated plasma cells that typically do not express CD20 but may be responsible for secretion of the abnormal IgM responsible for hemolysis in CAD

8

. Moreover, chronic inflammatory processes in autoimmune diseases can be sustained by long-lived plasma cells which continuously secrete pathogenic antibodies.  Proteasome inhibitors that target plasma cells like bortezomib could effectively weaken this antibody-producing category of cells. In view of its effect on malignant B cells and plasma cells, bortezomib has been used to treat other plasma cell disorders, with case reports of successful treatment of immune hemolytic anemia related to cryoglobulinemia, systemic lupus erythematosus, and myasthenia gravis

9

. Danchaivijitr et al reported that a combination of bortezomib and low-dose cyclophosphamide was successfully used to treat a patient with transfusion-dependent and steroid/rituximab-refractory AIHA

6

.

The combined use of prednisone, IVIG and bortezomib in our patient leading to her successful therapeutic outcome may make it difficult to discern which components of the combination therapy were responsible for the improvement in the hemolytic process. However, it is noteworthy that the observed sustained improvement in her hemoglobin level was noticed only after the introduction of bortezomib. Although steroids suppress antibody production and down‐regulate Fc‐receptor‐mediated red cell destruction in the spleen, reports indicate that their effect is not immediate and often takes 2-4 weeks to manifest

10

. Also, the effectiveness of high dose intravenous immunoglobulin has been more pronounced in children with AIHA secondary to infections rather than adults with idiopathic disease

2

.


Conclusion

Despite the availability of multiple therapeutic modalities, autoimmune hemolytic anemias especially the mixed type can be refractory to such interventions. Based on our experience with our patient and other reported cases, further research is imperative to further explore the potential therapeutic effects of bortezomib in nonmalignant disorders, including autoimmune hemolytic anemias.


References

  1. Kalfa TA: Warm antibody autoimmune hemolytic anemia.

    Hematology Am Soc Hematol Educ Program.

    2016 Dec 2, 2016(1): 690-697.
  2. Abdulgabar Salama: Treatment options for primary autoimmune hemolytic anemia: A short comprehensive review.

    Transfus Med Hemother

    2015;42:294-301.
  3. Bass GF, Tuscano ET, et al: Diagnosis and classification of autoimmune hemolytic anemia.

    Autoimmun Rev.

    2014 Apr–May; 13(4-5): 560-4.
  4. Gupta S, Szerszen A, et al: Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab: A case report.

    J Med Case Rep.

    2011 Apr 19;5:156.
  5. Sudha VR, Samayam P, et al: Autoimmune Hemolytic Anemia: Mixed Type – A Case Report.

    Indian J Hematol Blood Transfus.

    2011 Jun; 27(2): 107-110.
  6. Khandelwal P, Davies SM, et al: Bortezomib for refractory autoimmunity in pediatrics.

    Biol Blood Marrow Transplant.

    2014 Oct; 20(10):1654-9.
  7. Danchaivijitr P, Yared J: Successful treatment of IgG and complement-mediated autoimmune hemolytic anemia with bortezomib and low-dose cyclophosphamide.

    Am J Hematol.

    2011 Mar; 86(3):331-2.
  8. Carson KR, Beckwith LG, et al: Successful treatment of IgM-mediated autoimmune hemolytic anemia with bortezomib.

    Blood.

    2010 Jan 28; 115(4):915.
  9. Hosoba S, Jaye DL, et al: Successful treatment of severe immune hemolytic anemia after allogenic stem cell transplantation with bortezomib: Report of a case and Review of literature. Transfusion. 2015 Feb; 55(2): 259-264.
  10. George G, Petz LD, et al: The correlation of cold agglutinin titrations in saline and albumin with hemolytic anemia. Br J of Hematol. 1977 Apr; 35(4):587-95.

 

 

 

Strategy Proposal for Alcohol Addiction

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Propose a strategy to help reduce alcohol addiction based on your knowledge of current prevention, screening or intervention strategies.




Introduction

Addiction can be defined as a behavioural process that provides pleasure and relief from internal discomfort, however, it includes a recurring failure to control the behaviour and a continuation of this behaviour despite its harmful consequences. (Goodman, 1990) Addiction to alcohol is an excessive and harmful consumption of alcohol but with tolerance effects and withdrawal symptoms. It differs from alcohol abuse as alcohol abuse is excessive and harmful consumption without tolerance effects and withdrawal symptoms. However, alcohol abuse can often lead to alcohol addiction in the future. REFERENCE IF CAN.

Addiction to alcohol is one of the leading concerns in the world. Research has shown that alcohol is one of the leading causes of death. A study by Stahre, Roeber, Kanny, Brewer and Zhang (2014) showed that excessive drinking was responsible for 1 in 10 deaths among working age adults in the United States. This is because excessive drinking is a massive risk factor for many health related problems. Alcohol consumption is an underlying cause, either entirely or partly, for over 30 different conditions including cancer, diabetes, liver and pancreas diseases and many more. (Rehm, 2011)

It is also worrying that alcohol related deaths have been rising. A study in the UK by Breakwell, Baker, Griffiths, Jackson, Fegan, and Marshall (2007) found that alcohol related deaths had increased from 4,144 in 1991 to 8,221 in 2004 and in 2016 this rose to 9,214 according to the Office for National Statistics.

Alcohol related deaths have been rising due to the rise in alcohol consumption. Dawson, Goldstein, Saha and Grant (2015) looked at changes in alcohol consumption from 2001 to 2013 and found that the prevalence of drinking increased, as did the volume and frequency of drinking. It also found that the prevalence of monthly heavy episodic drinking increased among heavy drinkers.

These studies show that alcohol consumption and alcohol related deaths are rising and suggests that more needs to be done to try and reduce this. One way of attempting to reduce alcohol addiction is by prevention strategies. One of the best ways to try and prevent alcohol addiction is by educating adolescents about alcohol abuse as during adolescence is when most people starting drinking alcohol for the first time. O’Malley, Johnston and Bachman (1998) found that in the United States 54% of 13-14 year olds, 72% of 15-16 year olds, and 82% of 17-18 year olds had consumed alcohol. Thus showing just how young people start drinking alcohol.

Research has also shown that alcohol abuse is very common in adolescents. Harford, Grant, Yi and Chen (2005) found that the prevalence of alcohol abuse and of alcohol dependence with or without alcohol abuse was at its highest for the ages of 18-23 years old, this was followed by adolescents aged 12-27 years old. These results therefore suggest that adolescents do not just start drinking during adolescence but also start drinking excessively at a young age. It was also found that alcohol abuse was lowest for those over 50.

Therefore these results suggest that adolescents are most at risk of alcohol abuse, which can lead to alcohol dependence and then to addiction. Research has suggested that adolescents may be most at risk of alcohol abuse because of social factors, such as being susceptible to peer pressure. Dielman, Campanelli, Shope and Butchart (1987) found that susceptibility to peer pressure was highly correlated with high levels of adolescent alcohol abuse.

Many prevention strategies not only educate about the risks of substance abuse but also work on resisting social pressures and decision making in order to help prevent adolescents from abusing alcohol. Substance abuse prevention strategies are strategies that attempt to prevent substance abuse, including alcohol abuse. They are usually conducted in schools and aimed at adolescents. Currently used strategies include Project DARE (Drug Abuse Resistance Education) and the Life Skills Training Program by Botvin et al. (1984).

Project DARE (Drug Abuse Resistance Education) is a school-based intervention program taught by police officers that was designed to try and eliminate substance use, including alcohol, in adolescents. It focused on teaching peer resistance skills in the form of lectures, workbook exercises and role-playing sessions. (Rosenbaum, Flewelling, Bailey, Ringwalt and Wilkinson, 1994).

Clayton, Cattarello and Johnstone (1996) examined the effectiveness of DARE in a study where over 2,000 11-12 year olds were administered DARE. It was found that DARE produced some initial improvements in the students attitudes towards substance use, however these changes did not continue over time. It was also found that there was no effect on actual substance use. In the 5 year follow up it was also found that there had been no effect on actual substance use.

Lynam et al (1999) conducted a study across 10 years in order to test the effectiveness of Project DARE over a longer period of time. They had a total of 1,002 11-12 year old students receive DARE and then re-evaluated them when they were 20 years old. It was found that the participants levels of lifetime alcohol use and their positive and negative expectancies of alcohol before received DARE was significantly related to their levels of lifetime alcohol use and positive and negative expectancies 10 years later. This study suggests that Project DARE is not very effective and had no effect on trying to reduce or eliminate substance abuse. This is, however, an outdated study using an outdated version of DARE. Project DARE has been updated over the years and it is possible that a newer version may have been more effective. However, there has not been much change to DARE. The focus and aim of DARE has stayed the same, as well as the programs method of delivery according to Lynam et al. From the research on Project DARE it is clear that it is not an effective prevention strategy as the results from the studies on it have shown no effective on the alcohol consumption of the adolescents that received DARE.

The more recent and higher regarded prevention strategy is the Life Skills Training Program (LST) by Botvin et al. (1984). It is a school-based intervention program, taught by teachers, that targets a specific set of risk factors for alcohol and other substance abuse. It is a prevention program that aims to reduce the prevalence of substance abuse in younger populations. (Botvin and Kantor, 2000) It is taught across 3 years and uses cognitive-behavioural skills training techniques, group discussions and classroom demonstrations. It consists of three major components, personal self-management skills, social skills and drug related information and skills. (Botvin and Griffin, 2004)

A study by Botvin et al (1984) was conducted using 239 students from two public schools in New York that were randomly assigned to experimental and control conditions. The students in the experimental condition took part in 20-session program (LST) that targeted the major cognitive, attitudinal, social and personality factors that are believed to promote early stages of alcohol misuse. The program contained material on general social skills, decision making, coping with anxiety and resisting peer pressure as well as there being information about the short and long-term consequences of alcohol abuse. In the 6-month follow up the experimental group were contrasted with the control group, which did not receive LST, and it was found that 54% fewer students reported more frequent drinking, 73% fewer students reported heavier drinking and 79% fewer students reported getting drunk at least once per month.

LST has also been tested on its long-term effectiveness, Botvin et al. (1995) conducted a follow up study 6 years after adolescents received LST. They conducted telephone interviews and email surveys on the adolescents 6 years later and found that LST was effective in the long-term, as 66% fewer adolescents used polydrugs (alcohol, marijuana and tobacco) after having received LST. This suggests that LST is not just a good short-term prevention strategy as it has also been shown to be effective over a long period of time. However the results may not be reliable as the study was conducted using telephone interviews and email surveys to gather results. The participants could have been dishonest in these surveys as substance abuse can be a taboo subject so some of the participants may have chosen to lie about their substance abuse. Also only 60.4% of those who participated in the original study participated in this follow up study, if all of the original participants did the follow up study the results may have been different. The results of this study, if reliable, do show that LST is an effective prevention strategy.

However, not all research on LST has shown it to be a completely effective prevention strategy. Botvin et al. (1990) found that the LST program had negative effects on alcohol when it was delivered by teachers and with booster sessions. It was found that many teachers did not implement the program according the correct protocol. Botvin et al. pointed out that this may be because teachers are not sufficiently trained in teaching cognitive-behavioural life skills. Overall, research would suggest that LST is a fairly effective prevention program but that it can be improved and that alterations of the program could make it a much more effective prevention strategy.

From research it is clear to see that the current strategies are not currently effective enough in preventing alcohol abuse. Project DARE was shown to be largely ineffective and the LST program although shown to be effective in research could be much improved. That these current strategies are not effective enough is also evident through the fact that since these strategies have been implemented in schools there has still been an increase in adolescent alcohol use as shown by Johnston et al. (2018). Their study found that binge drinking rates had increased slightly since 2016, thus suggesting that the current strategies are not preventing adolescents from excessive drinking.

A proposed strategy for the prevention of alcohol addiction is an adapted version of the Life Skills Training Program, which much research has shown to be effective in both the short-term and the long-term. My adapted version of the Life Skills Training involves a number of changes that research has suggested could improve the effectiveness of it.

This adapted version of LST still has the three major components of LST, personal self-management skills, social skills and drug related information and skills. However, it will be a more interactive version of LST. Research by Tobler and Stratton (1997) found that drug prevention programs that were interactive were more effective than those that were not interactive. They also found that smaller interactive groups were more effective than larger interactive groups. In line with these results, I suggest that an adapted version of LST be interactive rather non-interactive. I also suggest that it be implemented in smaller groups of 10 students instead of it being implemented in regular classes as the research by Tobler and Stratton showed this to be more effective.

Another change that I would propose would try to bring more connectedness and rapport to the program. Having the teachers of the groups build rapport with the students could be highly beneficial to the effectiveness of the program. Rapport is built when the students have the opportunity to voice their perceptions with their teacher and their peers. (Brown, 2001) D’Emidio-Caston and Brown (1998) found that focus groups on drug education allowed students to hear the different sides to substance use. They suggested that hearing only one side of the story about substance use can alienate the students that are in most need of help. Therefore, focus groups will be an important focus of the proposed strategy as it will allow rapport to be built between students and their teacher and will help to involve those that are most in need of drug education. Research has shown that rapport building can be very beneficial for a student’s learning. Buskist and Saville (2004) found that students who experienced rapport with their teacher were more attentive, had increased class enjoyment and a higher attendance level.

It is also proposed that the teachers be fully trained in teaching cognitive-behavioural life skills as research by Botvin et al. (1990) suggested that teachers without this training may have been less effective at teaching LST to students. The researched showed that many did not follow the correct protocol of LST and did not teach substantial portions of the program. Having all teachers fully trained in teaching cognitive-behavioural life skills should lead to the strategy being implemented with full fidelity. Therefore this should make this prevention strategy even more effective.

In conclusion, it is clear to see that alcohol addiction is a massive worldwide problem and that current prevention strategies have not been successful enough in preventing alcohol addiction. Although prevention programs such as LST are highly regarded and are used in many states in the United States, it has not been effective enough to decrease the levels of alcohol addiction and alcohol abuse. There are many positive components to such prevention programs, however there is also a lot of room for improvement and the proposed strategy attempts to improve previous drug prevention strategies by making a more interactive version that will improve the connectedness between student and teacher and thus lead to better learning by the students. It also aims to do this by having the teacher fully trained in teaching cognitive-behavioural life skills as this will increase the effectiveness of the teaching and make the strategy more effective.


  • https://pubs.niaaa.nih.gov/publications/aa83/aa83.htm
  • Botvin, G. J., & Griffin, K. W. (2004). Life skills training: Empirical findings and future directions. Journal of primary prevention, 25(2), 211-232.
  • Botvin, G. J., & Kantor, L. W. (2000). Preventing alcohol and tobacco use through life skills training. Alcohol research and health, 24(4), 250-257.
  • Botvin, G. J., Baker, E., Botvin, E. M., Filazzola, A. D., & Millman, R. B. (1984). Prevention of alcohol misuse through the development of personal and social competence: A pilot study. Journal of studies on alcohol, 45(6), 550-552.
  • Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Jama, 273(14), 1106-1112.
  • Botvin, G. J., Baker, E., Filazzola, A. D., & Botvin, E. M. (1990). A cognitive-behavioral approach to substance abuse prevention: One-year follow-up. Addictive behaviors, 15(1), 47-63.
  • Breakwell, C., Baker, A., Griffiths, C., Jackson, G., Fegan, G., & Marshall, D. (2007). Trends and geographical variations in alcohol-related deaths in the United Kingdom, 1991-2004. Health Statistics Quarterly, (33), 6.
  • Brown, J. H. (2001). Youth, drugs and resilience education. Journal of Drug Education, 31(1), 83-122.
  • Clayton, R. R., Cattarello, A. M., & Johnstone, B. M. (1996). The effectiveness of Drug Abuse Resistance Education (Project DARE): 5-year follow-up results. Preventive medicine, 25(3), 307-318.
  • Dawson, D. A., Goldstein, R. B., Saha, T. D., & Grant, B. F. (2015). Changes in alcohol consumption: United States, 2001–2002 to 2012–2013.

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    , 56-61.
  • D’Emidio-Caston, M., & Brown, J. H. (1998). The other side of the story: Student narratives on the California Drug, Alcohol, and Tobacco Education Programs. Evaluation review, 22(1), 95-117.
  • Dielman, T. E., Campanelli, P. C., Shope, J. T., & Butchart, A. T. (1987). Susceptibility to peer pressure, self-esteem, and health locus of control as correlates of adolescent substance abuse. Health education quarterly, 14(2), 207-221.
  • Goodman, A. (1990). Addiction: definition and implications. British journal of addiction, 85(11), 1403-1408.
  • Harford, T. C., Grant, B. F., Yi, H. Y., & Chen, C. M. (2005). Patterns of DSM‐IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on Drug Abuse. Alcoholism: Clinical and Experimental Research, 29(5), 810-828.
  • Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use, 1975-2017: Overview, key findings on adolescent drug use.
  • Lynam, D. R., Milich, R., Zimmerman, R., Novak, S. P., Logan, T. K., & Martin, C. (1999). Project DARE: No Effects at 10-Year Follow-Up. Journal of Consulting and Clinical Psychology, 67(4), 590-593.
  • Office for National Statistics. (2016) Alcohol-specific deaths in the UK: registered in 2016. Retrieved from

    https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/alcoholrelateddeathsintheunitedkingdom/registeredin2016
  • O’Malley, P. M., Johnston, L. D., & Bachman, J. G. (1998). Alcohol use among adolescents. Alcohol Health & Research World, 22(2), 85-94.
  • Rehm, J. The risks associated with alcohol use and alcoholism. Alcohol Research & Health 34(2):135–143, 2011.
  • Rosenbaum, D. P., Flewelling, R. L., Bailey, S. L., Ringwalt, C. L., & Wilkinson, D. L. (1994). Cops in the classroom: A longitudinal evaluation of Drug Abuse Resistance Education (DARE). Journal of research in Crime and Delinquency, 31(1), 3-31.
  • Stahre, M., Roeber, J., Kanny, D., Brewer, R. D., & Zhang, X. (2014). Peer reviewed: contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Preventing chronic disease, 11.
  • Tobler, N. S., & Stratton, H. H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. Journal of primary prevention, 18(1), 71-128.

Mental Health: The historical care and treatment of people with a mental illness has provided strong evidence to underpin the need for less paternalistic, more inclusive models of care

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Mental Health: The historical care and treatment of people with a mental illness has provided strong evidence to underpin the need for less paternalistic, more inclusive models of care

The historical care and treatment of people with a mental illness has provided strong evidence to underpin the need for less paternalistic, more inclusive models of care. The recovery movement has driven the necessary re-visioning of mental health care service delivery on a worldwide scale. The empowerment and inclusion of consumers and carers in care planning and treatment is the foundation of the recovery movement. This shift has been reflected at all levels of service planning and care delivery and also within the legislation that governs the care, treatment and control of people who are mentally ill or disordered (NSW Mental Health Act 2007).

Assignment questions:
This assignment is organised within 4 parts:
Part a) requires you to describe the provisions for involvement of family and nominated carers in mental health treatment within the NSW Mental Health Act 2007 .
Part b) requires you to review a variety of literature and discuss the meaning of recovery within the context of mental health.
Part c) requires you to discuss nurses’ inclusion of consumers in planning their mental health care and treatment and how this participation has changed with the advent of the recovery movement.
In part d) describe how the active participation of consumers and nominated carers in planning care and treatment contributes to a person’s recovery in a mental health context.
Finally, write a short conclusion that analyses and Synthesises your discussion of the above areas with the implications for nurses across all areas of nursing practice.
TIPS FOR WRITING THIS WORK:
• This is an essay and therefore there should not be any headings within your work. Each section of discussion should end with a sentence or two that lead into the next section.
• Construct a short introduction that informs the reader of the areas you will be discussing in your essay (the four sections).
• Note that 50% of the marks for this work are attributed to how well you argue (critique) the information you are presenting, how well you write it and how you reference. Please apply a consistent approach to referencing (needs to be school style).
• As a guide, if you find one reference for each area of discussion you can only describe what the authors have said and this will attract a pass mark at best. To critically analyse, you need to source a few references for each point you are making and compare and contrast the authors different findings, or point out that they all agree (reach a conclusion).

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If healthcare rationing cannot be avoided, the question now becomes: What is the best way to conduct healthcare rationing such that it will conform with the ethical principles of autonomy, beneficence, non-maleficence, justice, fidelity and veracity?

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If healthcare rationing cannot be avoided, the question now becomes: What is the best way to conduct healthcare rationing such that it will conform with the ethical principles of autonomy, beneficence, non-maleficence, justice, fidelity and veracity?

 

ETHICAL DILEMMA AND BENNER STAGES

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READ the following chapters in your textbook:

•Chapter 2: Socialization to Professional Nursing Roles: Professionalism, Professional Socialization)
•Chapter 4: Ethical Foundations of Professional Nursing

2) Create and submit a blog for the following topics.

Ethical dilemma: Most healthcare professionals agree that healthcare rationing is currently occurring in the United States in different ways and forms; nursing is no exception. Some have alluded to the fact that healthcare rationing is ethically and morally wrong, however it cannot completely be eradicated. In a sense, health care rationing is needed for the survival of the healthcare delivery system.

a) Do you agree or disagree that health care rationing is happening in the US?

b) If healthcare rationing cannot be avoided, the question now becomes: What is the best way to conduct healthcare rationing such that it will conform with the ethical principles of autonomy, beneficence, non-maleficence, justice, fidelity and veracity?

Benner’s Stages from Novice to Expert: There are five levels of proficiency according to Benner. These are Novice, Advanced Beginner, Competent Practitioner, Proficient Practitioner, and Expert Practitioner

C) Where do you identify yourself on the Benner’s Stages of Novice to expert Stages of socialization process. Refer to module 5 blog below for the detailed prompts.

Discuss the value of best evidence as a driving force to institute change in delivery of nursing care.

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Discuss the value of best evidence as a driving force to institute change in delivery of nursing care.

Do the power point which is answering these two questions:

Discuss the value of best evidence as a driving force to institute change in delivery of nursing care.  Discuss the value of best evidence as a driving force to institute change in delivery of nursing care.

1- CO 8: Discuss the value of best evidence as a driving force to institute change in delivery of nursing care. (PO 8)

Identify how the use of the technology impacts patient care delivery, quality care measures and monitoring, as well as, risk management (privacy, confidentiality, and security). Based on what you have found in the literature, discuss why the technology has increased effectiveness of patient care and safety.

– CO 8: Discuss the value of best evidence as a driving force to institute change in delivery of nursing care. (PO 8)

Identify how the use of the technology impacts patient care delivery, quality care measures and monitoring, as well as, risk management (privacy, confidentiality, and security). Based on what you have found in the literature, discuss why the technology has increased effectiveness of patient care and safety.

DNP 835 Cultures That are Currently Influencing Healthcare

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DNP 835 Cultures That are Currently Influencing Healthcare

DNP 835 Cultures That are Currently Influencing Healthcare

 

Cultural Driven Healthcare Delivery – Write a 2000-2500 word
essay addressing each of the following points/questions. Support your ideas
with at least three (3) scholarly citations in your essay. Use strict APA
guidelines to format the paper. The cover page and reference page do not count
towards the minimum word amount and an abstract and table of contents are not
necessary and if included are not part of the overall word count.

Describe five cultures that are currently influencing
healthcare and effecting delivery decisions. Discuss each culture in detail and
describe potential challenges to healthcare delivery. Include a discussion of
how you would address nursing staff ensuring that these cultures were handled
with respect and appropriate care delivery behavior.

7 Ways Culture Influences Health Care

February 16, 2015 By admin Blog

healthcare

As a healthcare provider, broaching subjects on ethnic differences may not be on territory you want to tread. However, it’s an important part of providing care to your patients. Culture has a significant impact on both diagnoses and treatment options, primarily because of different social beliefs, but also because of biological factors. In order to improve the care of patients in general, health care providers should be aware of the following cultural influences.

ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:DNP 835 Cultures That are Currently Influencing Healthcare

1. Family and Community

Everyone retains certain beliefs as a result of family and community influences, especially in other countries. For example, Asians and Pacific Islanders rely heavily on their extended family. Oftentimes, the honor and interests of the family are more important than the interests of the individual. Understanding situations like this when administering health care can be very helpful in providing proper treatment.

2. Religion

For the truly zealous, religion is not just a hobby. It’s a way of life, and that can add barriers to typical treatments. Jews, for example, abstain from certain foods because of their religion, and therefore there will be dietary preferences to consider when outlining any sort of nutritional plan. Others may believe that their illness is an act of God and therefore refuse treatment.

3. Perspectives on Death

This is not a question about life after death or funeral rituals, but if doctors truly want to connect with and help patients, they will benefit from knowing the patients’ and families’ perspectives on dying. They will need to know the proper ways to handle end of life care and make the transition as comfortable as possible.

4. Gender Roles

Different genders will often have different beliefs regarding medical treatment. Women, for example, may request less invasive treatments to make them more comfortable. Likewise, gender roles within relationships can often play a role in hindering treatment. One partner in the relationship may be dominant and believe it’s his/her job to make all of the decisions.

5. Health Beliefs

Cultures often have different beliefs regarding health care in general. Caucasians generally have a low pain tolerance compared to other ethnicities and tend to have higher expectations regarding their physical recovery and expectations of receiving a prescription. On the other hand, those coming from a hispanic background desire quick relief, but are often less willing to trust American remedies.

6. Beliefs about Medication

As mentioned above, Caucasians have a lot of faith in prescription medication and modern treatments. Therefore, they are much more likely to take their medications as prescribed. Others cultural groups, such as African Americans and Native Americans, may doubt the need for such medication and stop taking it prematurely.

7. Responses to Medications

Perhaps one of the most important cultural influences has to do with the way a patient responds physically to medication. Some people from backgrounds other than Caucasian may not metabolize the medication correctly, causing serious complications in treatment. Caucasian patients generally tend to handle a wider variety of medications than those of other cultures do.

Broaching these subjects with your patients may be uncomfortable to begin with, but it may be the thing that saves your patient’s life and your career.

We at Fusion HealthCare Staffing pride ourselves in working with both employers and experienced professionals to meet the needs of the fast-paced and ever-changing medical field. Give us a call at 855-537-8353 today to discuss your employment or staffing needs.

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Do interventions aimedtowards at-risk mothers and infants reduce infant mortality during their first year of life in theUnited States?

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Do interventions aimedtowards at-risk mothers and infants reduce infant mortality during their first year of life in theUnited States?

 

 

chapter 3 has 4 pages that is already written. What I need is for each subtitle to rewrite the paragraphs in my own words as well for each subtitle there is a question for what the paragraphs is
suppose to be about make sure I have answer the question if not add to it. With Chapter 4 its 2 pages. What I need done on this part is to read each question and to my paragraph with more detail
and add charts and bar graph. Also both chapters needs a reference page all together it′s about 6 pages, needs to be free of grammar and plagiarism
CHAPTER 3. METHODOLOGYIntroductionThis section describes the design of the research used to answer the postposed hypotheses or address the research problem and then presents the following sub-sections:Data discussed in this article are based primarily on the linked birth/infant death datasets produced by the Centers for Disease Control and Prevention’s National Center for Health Statistics
(NCHS).5,8 In these datasets, information from the birth certificate is linked to information from the death certificate for each infant who dies in the United States. The purpose of the linkage is
to use the many additional variables available from the birth certificate for infant mortality analysis. We computed infant 1 year of age mortality rates per 100,000 live births for cause of death,
and per 1,000 live births for all other variables. Cause-of-death data were classified according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health
Problems.9 Leading CODs were ranked using the conventions outlined by NCHS and described in detail elsewhere.5 Research lacks long-term assessments of adherence regarding education provided within
hospital settings (Mason, 2013). Other limitations were a lack of randomized sampling (Dietz, England, Shapiro- Mendoza, Tong, Farr, and Callaghan, 2010), (Livingood et al., 2010), (Malloy, 2010).
Samples were limited to high risk women only (Livingood, 2010), and studies were predominately surveyed in urban communities (Kucik et al., 2014). Systematic reviews were utilized due to minimal
research regarding interventions to reduce infant mortality within the restricted time frame (Rowland, 2002). Overall, systematic reviews were useful in identifying interventions for infant
mortality, and health care workers are familiar with education topics to discuss with different populations. However, systematic reviews were not helpful when trying to obtain statistics and
effectiveness of research interventions.Research QuestionsState the proposed hypotheses (for a quantitative study) or research questions (for a quantitative or qualitative study) from Chapter 1 in the proper form and style. The PICOT question in this review is as follows: Do interventions aimedtowards at-risk mothers and infants reduce infant mortality during their first year of life in theUnited States? Risk factors and interventions focus on preventative prenatal care and postpartumeducation and care. This systematic review discusses and critically appraises research by experts who have evaluated the effectiveness of interventions to reduce rates. Based on the appraisal of
peer-reviewed publications about IMR interventions, advanced practice and research recommendations have shown to reduce the rate of infant mortality.Description of the ParticipantsWho are they, how they were selected for participation, and why were they chosen. Limitations were noted throughout the studies. Studies included singleton babies only (DaFrè et al., 2015) .Research is deficient of long-term monitoring and evaluation of an attachment
regarding education provided within hospital settings (Mason, 2013). Other limitations were a lack of randomized sampling (Dietz, England, Shapiro Mendoza, Tong, Farr, and Callaghan, 2010),
(Livingood et al., 2010), (Malloy, 2010). Samples were limited to high risk women only (Livingood, 2010), and studies were predominately surveyed in urban communities (Kucik et al., 2014).
Systematic reviews were utilized due to minimal research regarding interventions to reduce infant mortality within the restricted timeframe (Rowland, 2002). Overall, systematic reviews were useful
in identifying interventions for infant mortality, and health care workers are familiar with education topics to discuss with different populations. However, systematic reviews were not helpful
when trying to obtain statistics and effectiveness of research interventions..InstrumentationDescription and any history regarding any survey instruments used to obtain data (include any reliability measures associated with the instrument). . Levels of evidence varied with different research studies. Forty-three percent of the research articles were Level Six: Single Descriptive or Qualitative studies. Twenty-eight percent
were Level Five and Systematic Reviews of Descriptive and Qualitative Studies. Cohort and Case Control studies at Level Four and made up 14% of the studies. Finally, 9% of the studies generated
from Level Three evidence. Controlled Trials without Randomization, and Randomized Control Trials accounted 6% of Level Two evidence based practice. Sample sizes ranged from five (Salim, 2016) to
1,335,471 subjects (Malloy, 2010). Half of the studies were conducted at single sites, while 35% included multiple states. Fifteen percent of the studies were conducted nationwide. Overall, studies
providing education on reducing unsafe behaviors such as smoking, substance use, and lack of contraceptive use began to show that safe sleep increased along with patient compliance. Promoting
healthy outcomes by increasing health behaviors should decrease IMR, and all studies suggest that with patient compliance, lower rates are possible nationwide.Ethical ConsiderationsState how the study will adhere to established ethical norms. This includes how the study promotes the aims of research, promotes the values that are essential to collaborative work, how the
researcher is held accountable to the public, how it builds public support for the research, and how it promotes a variety of other important moral and social values. The current state of research continues to showcase IMRs throughout counties, states andnations. Research has focused on identifying risk factors related to infant mortality, but moreintervention studies about maintenance and long-tern effects need to be conducted to supportpractice. Hospitals are a major opportunity for both patient education and research. Safe sleep isa major, current topic of conversation occurring in facilities among healthcare providers andfamilies, and the compliance is noted in research to evaluate efficacy. Other new interventions inreducing infant mortality includes centering and inter-birth spacing. Research has begun toevaluate the effect of patient education and prevention. Both interventions are explained below.

If mentally capable, what preferences about treatment is the patient stating? If incapacitated, has the patient expressed prior preferences? Who is the appropriate surrogate to make decisions for the incapacitated patient? Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

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If mentally capable, what preferences about treatment is the patient stating? If incapacitated, has the patient expressed prior preferences? Who is the appropriate surrogate to make decisions for the incapacitated patient? Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

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?