Co-occurring Disorders: The Rule, Not The Exception : Constant MoutoniCAADEvents
A focused introduction to the importance of underpinning that a comprehensive understanding of a person’s behavioural, mental and emotional health issues, requires an understanding of the person, their environment and needs.
Joshua Riley presented for the Kolmac School in Silver Spring, MD on Friday, April 24, 2015. "Working with LGBT Substance Abuse Users and the Persistence of Methamphetamine Use Among Gay and Bi-Sexual Men" was adored by all. Enjoy his slides!
Co-occurring Disorders: The Rule, Not The Exception : Constant MoutoniCAADEvents
A focused introduction to the importance of underpinning that a comprehensive understanding of a person’s behavioural, mental and emotional health issues, requires an understanding of the person, their environment and needs.
Joshua Riley presented for the Kolmac School in Silver Spring, MD on Friday, April 24, 2015. "Working with LGBT Substance Abuse Users and the Persistence of Methamphetamine Use Among Gay and Bi-Sexual Men" was adored by all. Enjoy his slides!
Dodi Kelleher (Safeway) at Consumer Centric Health, Models for Change '11HealthInnoventions
Live Life, Live Long, Live Well™
An Evolving Health and Wellness Strategy. Dodi Kelleher, DMH
Director, Health and Wellness Initiatives, Safeway Inc.
One of the largest food and drug retailers in North America
200,000 employees and 1,725 stores across the US and Canada. Safeway health benefits offered to 30,000 corporate and store employees
Dodi Kelleher (Safeway) at Consumer Centric Health, Models for Change '11HealthInnoventions
Live Life, Live Long, Live Well™
An Evolving Health and Wellness Strategy. Dodi Kelleher, DMH
Director, Health and Wellness Initiatives, Safeway Inc.
One of the largest food and drug retailers in North America
200,000 employees and 1,725 stores across the US and Canada. Safeway health benefits offered to 30,000 corporate and store employees
Closing the treatment gap in alcohol dependence thessalonika 2015Antoni Gual
Lecture on the treatment gap (underdiagnose & undertreatment) of alcohol use disorders. Presented at the 5th Conference of the Greek Psychiatric society in Thessalonika, march 21st, 2015.
Characteristics and Outcomes of Adult Opiate Users in Abstinence-Based Resid...Siobhan Morse
Prior research in this population suggests that, overall, opiate and non-opiate addicted users have different issues and ought to be treated differently for their addiction—and that young and older adult opiate users present at treatment with different issues. This study investigated what significant differences in treatment motivation, length and outcome, if any, exist between opiate and non-opiate users and further investigates young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of any differences. Data for this study was drawn from 1972 individuals who entered voluntary, private, residential drug treatment and rehab. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and the University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and six-months post-discharge. Implications for addiction treatment providers and planners are discussed.
12Week IV, Discussion Post Care for the Client with a Substlauvicuna8dw
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
12Week IV, Discussion Post Care for the Client with a Substdrennanmicah
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
Assessment and Management of Disruptive Behaviors in Persons with DementiaVITAS Healthcare
This webinar helps physicians conduct a systematic evaluation for behavioral changes in persons with dementia. It offers approaches for developing a comprehensive care plan for disruptive behaviors.
12Week IV, Discussion Post Care for the Client with a Subst.docxherminaprocter
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
12Week IV, Discussion Post Care for the Client with a Subst.docxRAJU852744
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy.
Sexual Harassment Prevention For SupervisorsBernie McCann
A professional training seminar for supervisors and managers to assist them in recognizing potential sexual harassment in the workplace, hostile environments and how to address this behavior in employees.
Effective Telecounselling in the Eap SettingBernie McCann
This professional development presentation provides guidelines and best practices information for Employee Assistance and other mental health professionals when conducting brief counselling via telephone.
Responding in Times of Crisis: Providing Psychological First AidBernie McCann
A professional development presentation for credit union/bank branch managers to assist them in responding to employees and other victims of bank robberies.
A Proactive HR Approach To Workplace Stress ManagementBernie McCann
A Presentation to Human Resources Committee of a local Chamber of Commerce to illustrate the "big picture" of organizational development approaches to managing stress in the workplace.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Learning Objectives:
1. Discuss EA competencies and skill set
utilized in workplace substance abuse and
mental disorders.
2. Review recent advances in evidence-
based treatment and case management of
CODs relevant to EA practice.
3. Illustrate how both a renewed
emphasis & new information
have the potential to increase
positive COD outcomes in the
EAP setting.
3. Historical Development of EAPs
19th Century Influences:
Employers: Welfare Capitalism
Trade Unions: Communal Brotherhood
1940s - Occupational Alcoholism Programs
1960s - Slow growth, mostly in mfg/indus sector
1970s - NIAAA recruits “Thundering 100”
1980s - ‘Broadbrush’ approach = ‘modern’ EAP
1990s - Expansion & Integration
Managed Care, Work/Life, CISDs, etc.
2000s - Market Expansion & Product Shrinkage
EAP as a Commodity – Price anemia, Quality issues
4. Today’s EAPs are designed to impact:
Organizational
Goals
EAP
IMPACT
Health Claims Human Capital
6. Enrollment in EAP
1993-2003, by Type
60
50
52.8
40
30
20
27.4
20.0
10
7.2
0
1993 2003
EAP only EAP + MBH
7. Current Challenges for EAPs
• Increased pressure on EAPs to demonstrate a unique
contribution to enhanced workplace productivity and
health care cost containment; as an increased
responsibility/accountability for safety-sensitive
situations.
• Current data on substance abuse, mental disorders
prevalence and cooccurance of these conditions reveals
many more Americans could benefit from intervention
(at all levels).
• Enhanced EA efforts to identify and assist those
employees with cooccuring conditions has potential to
demonstrate increased value and better client outcomes.
8. Major Factors on EAP Effectiveness
Major shift from internal to external delivery of
EAPs has resulted in:
1) new “occupational profile” of EA providers; and
2) community-based provider network delivery less
integrated with employee’s worksite & productivity
Increased market competition has diversified EA
services and products (diluted effectiveness?)
Rise in overall health care costs = reduced access to
TX for SUDs & MDs
9. Substance Use & Mental Disorders
15.2 15.4
Million Million
4.6
Substance Million Severe
Use Mental
Disorder lllness
Only Only
Co-occurring
Disorders
10. Substance Abuse & Co-Morbidity
• Adult lifetime co-occurrence of mood,
anxiety, anti-social personality disorders
& severe mental illness with substance
abuse is approximately 50%.
• The presence (and resolution) of co-
morbid factors is a primary & critical
success factor in sustaining recovery
from substance use disorders.
11. Some Explanations for Co-morbidity
1. Substance-induced temporary mental
conditions
2. Substance use (extent variable) may
intensify prior psychiatric disorders
3. Some psychiatric disorders likely to
increase risk factors for substance use
disorders
12. Sadness vs. Depressive Symptoms in
Alcoholics/other addictions
• 80% Experience some level of sadness
• 30% - 40% meet DSM criteria for
‘Depressive Episode’
• ‘Chicken or Egg?’; ‘self medication’? –
little neurological evidence to resolve
13. CODs in Insured People with SUDs
Of 774 patients in a large HMO:
Patients without SUDs Patients with SUDs
Depression 3% 29%
Injury/Overdose 12% 26%
Anxiety 2% 17%
Lower Back Pain 6% 11%
Headache 4% 9%
Major Psychoses 0.4% 7%
Hypertension 3% 7%
Asthma 3% 7%
Arthritis 1% 4%
Cirrhosis (Liver) 0.1% 1%
Source: Mertens JR, Lu YW, Parthasarathy S, et al. Medical & psychiatric conditions of
alcohol & drug treatment patients in an HMO. Arch Intern Med. 2003;163: 2511 - 2517.
14. Mental Disorders in EAP Settings
• Generalized Anxiety Disorder*
• Post Traumatic Stress Disorder*
• Panic Disorder
• Social Phobias*
• Obsessive-Compulsive Disorder
• Dysthymia*
• Depression
*May actually be occupationally induced
16. CODs: Clinical Implications
More prevalent than earlier appreciated
Related to reluctance to seek TX
Implicated in failure to engage in TX
Contributes to higher relapse rates for both
SUDs & MDs
17. Suicide as a risk factor for CODs
• 10.4% of adults who suffered a major depressive
event attempted suicide, 14.5% made a suicide plan,
40.3% thought about killing themselves, and 56.3%
thought that it would be better if they were dead.
• Rates went higher when depression was co-occuring
with alcohol or other drug abuse - rate of suicide
attempts rose 14% percent among binge drinkers,
and 20% higher among those who used illicit drugs.
Source: SAMHSA Suicidal Thoughts, Suicide Attempts, Major
Depressive Episode, and Substance Use Among Adults
– JT Online Summary, 9/19/2006
18. Nicotine Dependence: a COD health cost factor
• Smoking is the most preventable cause of death in
American society. Nearly 1 in 5 US deaths results from
the use of tobacco; more than 400,000 die from smoking
in the U.S. each year alone.
• Smoking actually kills more alcoholics than alcohol.
Pharmacological interactions between alcohol & nicotine
are critical determining factors in the very common co-
occurrence of chronic drinking and smoking.
• Cigarette smoking exacerbates alcohol-induced brain
damage. Recent neuroimaging studies of chronic
smokers have shown brain structural and blood-flow
abnormalities
20. Screening vs. Assessment
• Screening - a process to identify an
individual’s characteristics of problem drinking,
substance abuse or dependency through
established criteria, & which may indicate more
in-depth assessment.
• Assessment - more extensive analysis of
substance use, abuse or dependency -
specifically for level of severity, contributory
factors, & any associated consequences.
21. COA EA Practice Standard: Assessments
Clinical assessments should include:
• Review of physical illnesses, somatic
variables, medical treatment
• Use of alcohol and any other drugs
• Behavioral and cognitive patterns
leading to health risks
• When appropriate: legal, vocational,
and/or nutritional needs of employee
Source: Intake, Assessment and Service Planning.
Council on Accreditation Requirements, 2nd Edition XI.4.01
22. EAP Best Practices – Co-occurring Disorders
• A comprehensive assessment for SUDs indicates
a psychiatric assessment for presence of co-
occurring disorders, and vice-versa.
• Failure to address co-occurring disorders leads to
shorter lengths of abstinence and more frequent
relapses (an estimated 20 - 30% reduction in
treatment effectiveness).
• Treatment referrals, case management, aftercare
and follow up should consider the duality of any
co-occurring diagnosis to ensure effectiveness.
23. Enhanced EAP Worksite Approach
Pressure points for an EAP might include:
• Increase screening for SUDs/MDs + CODs
• Increase worksite awareness efforts
• Provide web-based information & referrals
• Increase level of supervisory training
• Expand support for workers in recovery
24. Enhanced Case Management for CODs
Integrated SA & MH assessments
Use of evidence-based
motivational interviewing, cognitive-behavioral
and family counseling approaches
EAP as the primary, central case manager
More frequent, structured follow-up and/or
compliance monitoring - à la Impaired
Professional Committees in health professions
25. MI = Progressive Continuum of Support
Follow-up
Engage client in behavior change
Establish action steps
Review motivation for change
Ascertain client goals
Education
Assessment
Screening
26. Maximizing EA Effectiveness in
Co-occuring SUD/MD Interventions
1. Earlier screening for identification of risky drinking,
problem drinking, pre-morbid substance abuse
2. More comprehensive assessments for appropriate,
cost-beneficial treatment referrals
3. Use of motivational interviewing for optimum
intervention and maximum client compliance
4. Closer EAP case management & increased follow up to
ensure greater adherence to treatment plans
5. Greater use of performance measures and outcome
reports to support continued expansion of services.
27. Demonstrating Value to Employers
• Tell them about it – Starting with
Orientation and Management training
• Incidence stats/Industry prevalence
• Conduct a quantitative worksite study
• Keep detailed records of services
• ‘Cost-out’ services provided
• Conduct case reviews of actual costs
& outcomes, to demonstrate the
savings/benefits of interventions